【正文】 ?不透 X線部分 : Radiopaque disk, lens shaped, four thin struts cross in middle, closed cage design. ?使用時間 : 1967停止時間不詳，非連續(xù)使用 Harken P2 31 Harken Valve: 流出道觀，關(guān)閉狀態(tài) 32 Harken Valve: 側(cè)面觀 33 Harken Valve: 斜面 流入道觀，開放狀態(tài) 34 KayShiley MGCD Series ? Models: KayShiley MGCD Series ? Type: Mitral caged disk valve with muscle guards ? Materials: DiskDelrin。 CageHaynes 25。 Sewing ringTeflon. Struts are uncovered, guards covered. ? X Ray: Two thin sets of parallel struts for cage, disk is faintly visible, two parallel bars surround 2/3 sewing ring to form muscle guards ? Dates: 19681980 (Discontinued) 35 36 雙頁（ Bileaflet） 碟瓣 ?最早、最主要、最成功的是 St. Jude瓣，它的成功導致了許多模仿的設(shè)計，但其仍為美國植入最多的機械瓣膜。其他一些雙頁瓣，包括 Carbomedics瓣和 EdwardsDuromedics瓣目前在美國已很少使用。 ?模仿的設(shè)計，多是對其懸掛系統(tǒng)的小的改進，其中最有競爭力的是 Medtronic parallel瓣。 ? ATS Bileaflet Valve ? Carbomedics Valve ? Edwards Duromedics Valve ? Medtronic Parallel Valve ? OnX Valve ? St. Jude Valve 37 ? Models: standard, HP series (supraannular cuff), Masters Series (rotatable ring, supraannular cuff) ? Design: Mitral, aortic, tricuspid ? Manufacturer: St. Jude Medical, Inc. ? Materials: Cagepyrolitic carbon。 diskpyrolytic carbon。 sewing ringdouble velour knitted polyester. Standard and HP ring attached with sutures (nonrotatable), Masters Series attached with helical spring and two retainer rings and is rotatable. ? Sizes: Aortic:1925 mm, Mitral:2533 mm St. Jude valve 38 ? Durability: A few cases of disc fracture reported, most were probably due to surgical trauma during implantation. Estimated MTBF 1,572*. ? X Ray Appearance: The standard and HP St. Jude valves are only visible on Chest Xray if leaflets caught edge on. Otherwise they are not visible and are known on our xray rounds as the Stealth Valve. The new Masters Series valves have a metal spring and 2 metal retainer rings and are visible on xray as a circular metallic ring. For all models, the leaflets open to 85 degrees from horizontal. The angle between open leaflets should therefore be 1011 degrees. When closed, the angle between leaflets should be 120 degrees ? MRI Compatibility: MRI imaging safe. Masters Series safe but probably cannot be visualized well on MRI due to metal in sewing ring ? Dates: 1977 to Present. 39 40 St. Jude Mitral Valve 41 St. Jude Valve Inflow 42 組織瓣 組織瓣由采用的材料分類，材料的來源為動物或人體組織。使用的組織類型可以是瓣膜組織，也可以不是瓣膜組織。 43 人體組織瓣 Human Tissue Valves ?無排斥反應，不用免疫抑制治療 ?人體組織瓣的應用有兩種： ?同種異體移植 ,Homografts ：將一個瓣膜從一個人移植到另一個人。 ?自身移植 ,Autograft：從本人的一個部位移植到另一個部位。應用最多的自身移植是將肺動脈瓣移植到主動脈瓣，稱為 Ross手術(shù)。 44 45 動物組織瓣膜 (異種移植物 xenograft) ? Porcine Valves ? Hancock Porcine Valve ? CarpentierEdwards Porcine Valve ? Tissuemed Stented Porcine Valve ? Pericardial（ 心包） Valves ? CarpentierEdwards Pericardial Valve ? IonescuShiley Pericardial Valve ? Hancock Pericardial Valve ? Stentless Valves ? St. Jude Toronto SPV (Stentless Porcine Valve) ? Medtronic Freestyle Stentless Aortic Valve ? Tissuemed Stentless Pulmonary Valve 46 ? Type: Stented aortic porcine valve ? Manufacturer: Medtronic Inc. ? Materials: Porcine aortic valve leaflets, glutaraldehyde processed, on a polypropylene flexible stent reinforced with a metal ring (Haynes alloy no. 25) at base。 sewing ring Polyester with silicone rubber insert ? Available in US: Yes ? Sizes: Aortic 23 mm 31 mm ? Durability: 10 years 90%, 15 years 50% ? X Ray Appearance: Single round metal O ring. ? Dates: 1969 to present Standard Hancock Model 242 47 48 ? Type: model 6625 Mitral and model 2625 aortic porcine tissue valves ? Manufacturer: BaxterEdwards Inc. US ? Materials: Porcine valve tissue fixed in glutaraldehyde, stents made of wire, Elgiloy, which is a cobaltnickel alloy。 sewing ringknitted Teflon ? X Ray Appearance: A continuous thin wire bent into 3 U shaped loops ? Available in US: Yes ? Sizes: Mitral 25 mm 35 mm ? Durability: 10 and 15 year durability probably similar to Hancock valve. ? Dates: 1975 to present CarpentierEdwards porcine valve 49 50 CE Pericardial Valve ? Manufacturer: Baxter Healthcare Corporation, Edwards CVS Division. US Manufacturing plant in Irvine, CA. ? Available in US: Yes ? Sizes: Aortic:1927 mm, Mitral:Not available yet. Some surgeons have implanted large aortic valves in the mitral