邓茗丹, 魏薪, 唐红, 等.超声心动图在主动脉瓣反流患者经心尖主动脉瓣植入术中的应用.四川大学学报(医学版),2017,48(6):941-945
超声心动图在主动脉瓣反流患者经心尖主动脉瓣植入术中的应用
Application of Echocardiography to Support Transapical Transcatheter Aortic Valve Implantation in Patients with Aortic Regurgitation
  
中文关键词:  超声心动描记术经导管主动脉瓣植入术主动脉瓣反流
英文关键词:EchocardiographyTranscatheter aortic valve implantationAortic regurgitation
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中文摘要:
      目的 探讨超声心动图在主动脉瓣反流患者经心尖主动脉瓣植入(transcatheter aortic valve implantation, TAVI)术前、术中及术后的作用。方法 31例中-重度单纯主动脉瓣反流或以主动脉瓣反流为主的外科开胸手术高风险患者行经心尖TAVI术。术前经胸超声心动图(transthoracic echocardiograghy,TTE)评估主动脉瓣反流程度、测量主动脉根部相关指标、左室收缩功能;术中介入操作前经食管超声心动图 (transesophageal echocardiography,TEE)再次准确评估,瓣膜植入过程中TEE联合X光造影指导人工瓣膜植入、监测并发症,术后即刻评估有瓣周反流及程度;术后1周、1月TTE随访人工瓣膜血流动力学参数、有相关并发症、左室收缩功能。结果 31例患者中,29例成功完成经心尖TAVI术。术后微量或瓣周反流23例,轻度瓣周反流6例。左室舒张期内径、左室质量指数术后1周较术前显著减小,术后1月进一步减小( P均<0.05),左室大小基本恢复正常;左室射血分数术后1周较术前降低( P<0.05),术后1月恢复至术前水平。结论 经心尖TAVI术对于外科开胸手术高风险的主动脉瓣反流患者是一种安全有效的治疗方式,超声心动图在TAVI术前筛查及测量、术中监测、引导和术后随访中起着不可或缺的作用。
英文摘要:
      ObjectiveTo explore the role of echocardiography in pre-procedural, peri-procedural and post-procedural stages of transapical transcatheter aortic valve implantation (TAVI) in patients with aortic regurgitation (AR).Methods31 patients with pure/dominant AR at a high risk on surgery were enrolled in this study. The degree of their aortic regurgitation was evaluated before TAVI, as well as the related diameters of aortic root and the left ventricular systolic function measured by transthoracic echocardiography (TTE). TEE was used to reevaluate the valve pathology after general anesthesia. TEE in combination with fluoroscopy provided accurate position of the prosthetic valve for implantation. TEE was also used to monitor complications and to evaluate immediate post-procedure paravalvular regurgitation. The post TAVI follow-up included valve heamodynamic status, complications, left ventricular systolic function and left ventricular mass index (LVMI) measured by TEE. ResultsTransapical TAVI was successful in 29 of the 31 patients: 23 experienced no or little paravalvular regurgitation; 6 had mild paravalvular regurgitation. The left ventricular end-diastolic diameter (LVDd) and left ventricular mass index (LVMI) of the patients decreased significantly one week after TAVI, which progressed until one month later ( P<0.05). The left ventricular ejection (EF) of the patients also decreased one week after TAVI( P<0.05), but it resumed to the pre-procedural level one month later. ConclusionTransapical TAVI is a potentially safe and effective therapy for patients with pure/dominant AR at a high risk on open-heart surgery. Echocardiography plays an important role in pre-procedural evaluation, peri-procedural monitoring and post-procedural follow-up in TAVI.
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