Lỗ van với những "dụng cụ", và từ cả hai phương pháp tiếp cận, đôi khi đã thành công. Thật không may, lực lượng và "đẩy" cần thiết để thâm nhập vào các van, thường xuyên đẩy ống thông hỗ trợ, trong đó có kim cứng và / hoặc dây ngược, phía sau và đi từ van đĩa chứ không phải là gây ra các dụng cụ đục lỗ để thủng van. | CHAPTER 31 Purposeful vascular perforations and to the valve. Valve perforations with each of these instruments and from both approaches occasionally were successful. Unfortunately the force and push that were necessary to penetrate the valve often pushed the supporting catheter which contained the stiff needle and or the retrograde wire backwards and away from the plate-like valve rather than causing the perforating instrument to puncture the valve. When the guide or support catheter was pushed away it prevented the perforation or even worse displaced the sharp instrument away from the center of the plate-like valve and into the perivalvular area. A puncture into the adjacent areas resulted in perforation into the pericardium and or an adjacent chamber vessel often with catastrophic results. Experimental and recently clinical experience demonstrated thefeasibility of drilling through tissue and more specifically pulmonary valve tissue with laser or rgdio-trequfnoy oao fnebgy. llottenwgv trurcuy have demosstrated rogiiyhtable hr etTating the vatveiSVhen shcsts fohgwgdbq a hatlogn diSaqon of the v ve Ohry abgguate pqlmonygy vtlgeoqemnqr ere bthfeaed ollqwlhg viqdqtnqaool progrqgc blaog llnog h tntue pulmonaeynitevyiTheamounioftnirvrrgradb fl gc Ofgn it yependeqtontge rseeof thb haitfosejte vaivs bga ifui bshaf hofqmy iirn the aomplisnceol she riuhlveqtricie. Laserenervywtsthefirsten rg ooueae rubt oVOn efubcal trials ft Euro 5 The laseo yoeygy ts detiuerqd tht-oyof s fl-e ffooroptic sttand or wire to g very spodfk hreSljilid a cghdveruiuacssfftt t rff ie s ttmatreha Onlmbnat Vbivetypetieuiswith qulmonatbVdlvestre-siabb essentiallovaporlajng tha tissueih d t fti e earn to. laseo ieam uyfdnungtelyi 1st se 7i enntinuen toptrforgtetrny ticsubs tnirs yotfbeyond ved oo du ione toths gaiviyThetiieCT euoqgywen ushar f lyt ntb r if nn opeein- in ths atteiic pulmtnooy eafqt yo approxhnale e 80 uf the ana mm bur a patíeuts ia wtom if way tfind pihsny. Tbs bpenmg .
