International Circulation: Last March your report “First Percutaneous Transcatheter Aortic Valve-in-Valve Implant With Three Year Follow-Up” appeared in Catheterization and Cardiovascular Interventions. The CoreValve prosthesis has maintained proper function up to three years with no structural deterioration or migration. Treating mixed aortic valve disease with predominant AR is feasible. Is there any possibility that PHV-in-PHV can be used in other situations?
《国际循环》：去年三月您在《Catheterization and Cardiovascular Interventions》杂志上发表的文章中提到，CoreValve瓣膜可维持正常功能达三年而不发生结构退化或移位，治疗以主动脉瓣返流为主的混合性主动脉瓣疾病是可行的。那么是否存在PHV-in-PHV用于治疗其他情况的可能性？
 
Prof. Ruiz: Hypothetically at this point it will be possible with percutaneous techniques but we are not there yet. The valves that have currently been designed are mostly for patients with aortic stenosis. Having had previous experience with the CoreValve self-expanding prosthesis I would say the valve can be used for AI. In the longest surviving patient， which I did with Dr. Condado and Dr. Laborde in Caracas almost five years ago， she had a mixed lesion of mild to moderate AS and severe AI. This patient showed that it can be done. In primary AI it is difficult to say at this point because the experience is limited to less than a handful of cases.
Prof. Ruiz：在这方面理论上有可能用经皮技术，但是我们尚未实现。目前设计的瓣膜大多针对主动脉狭窄的患者。根据我用CoreValve自膨式人工瓣膜的既往经验，该瓣膜可用于主动脉瓣关闭不全。对于原发性主动脉瓣关闭不全，这一手术的可行性目前还很难明确，因为现有经验仅限于少量病例。
International Circulation: In 2005 you published an article entitled “Transcatheter Placement of a Low-Profile Biodegradable Pulmonary Valve Made of Small Intestinal Submucosa: A Long-Term Study in a Swine Model” in Thoracic and Cardiovascular Surgery. The result shows the small intestinal submucosa valve has the potential for graft longevity without the need for anticoagulation or immunosuppression. What is the current status of this valve? When will it be ready for clinical usage?
《国际循环》：2005年，您在《Thoracic and Cardiovascular Surgery》上发表的文章中，结果显示，小肠黏膜下层瓣膜具有移植寿命长的潜力，而无需抗凝或者免疫抑制。这种瓣膜目前情况怎样？它何时可以用于临床？
 
Prof. Ruiz: The valve that you are referring to is made with a material called small intestinal submucosa from pigs. This submucosa is collagen based with some growth factors. The rationale for using a material like that is to allow the leaflets to remodel and become biologically inactive so that they do not react to the clotting system and they do not have fibrosis and degenerative calcification as happens with the biological prostheses that are currently used that have been pretreated with multiple substances to prevent degeneration. This work is still investigational and we are not at the point of trying these valves in humans.
Prof. Ruiz：你所提及的这种瓣膜是用来自猪的小肠黏膜下层的组织材料制成的。这种黏膜下层以胶原为基础，含有一些生长因子。使用此类材料的原理是让重塑瓣叶，并在生物学上失活，这样它们就不会对凝血系统产生反应，不会发生纤维化和退行性钙化，像在目前所用的生物瓣膜中发生的一样，这些瓣膜需要用多种物质预处理以预防退化。这项工作仍处于研究阶段，我们目前尚未尝试在人类中应用此类瓣膜。

International Circulation: In 2006 you published an article entitle “Cardiac Computed Tomography Compared to Transthoracic Echocardiography in the Management of Congenital Heart Disease” in Catheterization and Cardiovascular Interventions. The results showed TTE was more suitable for cardiac valves and septal defects because of the availability of flow imaging rather than computed tomography. Does this deny the diagnostic utility of cardiac computed tomography in congenital heart disease? What is the advantage of CT in the diagnosis of CHD?
《国际循环》：2006年，您在《Catheterization and Cardiovascular Interventions》上发表研究结果显示，经胸超声心动图（TTE）更适合心脏瓣膜和间隔缺损患者的检查，因为血流成像比计算机断层扫描（CT）更适用。这是否否定了心脏CT在先天性心脏病中的诊断用途？CT在先天性心脏病的诊断中有哪些优点？
 
Prof. Ruiz: The article was written in 2006 and since then we have continued our work on 3D and 4D imaging based on CT. Presently， in regard to valve implantation I think everyone would agree it is fundamental to have the CT information. There is information that the echocardiography can not provide because of the nature of the imaging technology. The echocardiography has very high   spatial resolution down to 4 milliseconds or better but the CT has the best spatial resolution. The echocardiography has the best temporal resolution and the CT has the best spatial resolution. It gives us the landmarks on where to position the valve and I think the combination of the CT with fluoroscopy will be the future for these technologies on how to properly deploy these prostheses.
Prof. Ruiz：目前关于瓣膜植入，获得CT信息是最基本的，大家都会同意这一点。但是，有一些信息是心动超声无法提供的，这是由于成像技术的本质特点所致。心动超声具有很高的空间分辨率，可达4毫秒甚至更佳，但是CT则具有最佳的空间分辨率。它能为我们提供瓣膜放置的位置标志，我认为，CT和透视技术的联合使用将成为正确开展修补技术的未来。

International Circulation: You are a member of the board of EuroPCR. Is there an increasing prominence here at EuroPCR and other conferences of percutaneous valve replacement? Has been an increase in the presentation and development of these techniques?
《国际循环》：您是EuroPCR委员会成员。此次EuroPCR会议和其他会议上经皮瓣膜置换术是否越来越突出？这些技术的介绍和发展是否有所增加？

Prof. Ruiz: Certainly. This has been the most explosive event that has occurred in interventional cardiology since Andreas Grundzig developed the coronary angioplasty. This has been seen at the TCT meeting with the prominence of the sessions for percutaneous valves for both repair of the mitral valve as well as for replacement of the aortic and pulmonary valves. The same thing at the i2 summit at ACC a few months ago， and you can see it here at EuroPCR where the sessions for percuataneous valves are packed. There is a tremendous excitement about this new technology because it opens the door for many patients who had no options and more importantly is the resurgence of the collaboration between the surgeons and interventionalists. It did not happen with coronary interventions but this can be the only way that percutaneous valve interventions will succeed.
Prof. Ruiz：当然，这是自Andreas Grundzig发展冠状动脉成形术以来介入心脏病学界所发生的最具爆炸性意义的事件。TCT会议和此次会议中，经皮二尖瓣修复以及经皮主动脉瓣和肺动脉瓣置换这部分非常突出。几个月前ACC的i2峰会上亦是如此，而且你也可以看到，这次的EuroPCR会议上充满了关于经皮瓣膜方面的讨论。这一新技术极为令人兴奋，因为它为许多走投无路的患者开启了一扇大门，更为重要的是，外科医生和介入医生之间相互协作再现。协作对于制定成功的计划，从而对患者进行最佳医疗而言是最基本的。

International Circulation: One of the themes here at EuroPCR is to do it for the patient. The collaboration seems very crucial to the outcome for the patient.

Prof. Ruiz: I can not express how fundamental that collaboration is to have a successful program for the best care of the patient. We can no longer rely on one single person’s decision as it happens many times with coronary interventions. The surgeons have been leaders in this field for many years. They have the most experience and it is fundamental to have their support and collaboration to establish a unique program that can offer the best solution for the patient.

International Circulation: It seems that it really is moving towards a team approach so the patient can make the most informed decision about their care