经食管超声心动图在经导管二尖瓣夹合术中引导两枚MitraClip置入的价值  

The value of transesophageal echocardiography to guide the implantation of 2 pieces of MitraClip during transcatheter mitral valve repair operation

作　　者：余蕾[1] 蒲朝霞[1] 刘先宝[2] 鲍晓峰[1] 黄品同[1] 何伟[3] 冯燕[2] 林剑靖[2] 游向东[1] 王建安[2] 

机构地区：[1]浙江大学医学院附属第二医院超声诊断科,杭州310009 [2]浙江大学医学院附属第二医院心内科,杭州310009 [3]浙江大学医学院附属第二医院麻醉科,杭州310009

出　　处：《中华心血管病杂志》2015年第4期347-351,共5页Chinese Journal of Cardiology

摘　　要：目的 探讨经食管超声心动图（TEE）在经导管二尖瓣夹合术中引导两枚MitraClip置入的价值.方法 回顾性分析2013年10月至2014年6月在我院行TEE引导下经导管二尖瓣夹合术并置入两枚MitraClip的6例有症状重度功能性二尖瓣反流患者的临床资料,评估第2枚MitraClip的置入时机,及介入治疗的即刻效果.结果 6例患者在置入第1枚MitraClip后,二尖瓣反流程度均≥2级且为中心性反流,即刻二尖瓣平均跨瓣压差＜3 mmHg（1 mmHg =0.133 kPa）,判断可以置入第2枚MitraClip.在置入第2枚MitraClip后,6例患者的二尖瓣反流量均较术前下降≥2级,其中3例降至1级,另外3例降至2级.术后即刻二尖瓣反流量降至2级的患者中,2例患者因第2枚MitraClip置入后即刻二尖瓣平均跨瓣压差为3 mmHg,而结束手术;1例患者因第2枚MitraClip置入后二尖瓣反流束较分散,没有适合位置置入下一枚MitraClip,而结束手术.手术均顺利完成,术中未出现介入治疗失败转外科开胸治疗、心肌梗死以及死亡等不良事件,无MitraClip脱落、血栓栓塞、二尖瓣结构损伤、二尖瓣狭窄、心包填塞等并发症.结论 TEE在经导管二尖瓣夹合术中引导两枚MitraClip置入的过程中起重要作用,二尖瓣平均跨瓣压差和MitraClip置入后反流的起源位置是决定能否置入下一枚MitraClip的关键.Objective To investigate the value of transesophageal echocardiography to guide the implantation of 2 pieces of MitraClip during transcatheter mitral valve repair operation.Methods From October 2013 to June 2014,6 transcatheter mitral valve repair operations were performed in our hospital for symptomatic patients with severe functional mitral regurgitation （MR）,transesophageal echocardiography was applied to guide the implantation of 2 pieces of MitraClip.Clinical data are retrospectively analyzed to evaluate implantation timing and approach of the 2nd piece of MitraClip,as well as the immediate effect of the interventional therapy.Results After implantation of 1st piece of MitraClip,transesophageal echocardiography evidenced MR ≥ grade 2 with central regurgitation and immediate mitral average transvalvular pressure gradient 〈 3 mmHg（1 mmHg =0.133 kPa） in these 6 patients and 2nd piece of MitraClip was implanted in these patients.After implantation of 2nd piece of MitraClip,it is observed via transesophageal echocardiography that mitral regurgitations were reduced by ≥ 2 grades for all 6 patients.For 3 patients,MR was reduced to grade 1.For the other 3 patients,MR is reduced to grade 2.Among the 3 patients whose MR was reduced to grade 2,2 operations were stopped because immediate mitral average transvalvular pressure gradient equaled to 3 mmHg,and the rest 1 operation was stopped because MR was too diverse and not able to select proper position to implant the next MitraClip.All 6 operations are completed successfully.There were no myocardial infarction,death or complications requiring mitral valve surgery after the MitraClip procedure.There were also no MitraClip detachment,thrombus embolism,mitral valve apparatus injuries,mitral stenosis,pericardial tamponade post procedure.Conclusions Transesophageal echocardiography plays an important role to guide the implantation of 2 pieces of MitraClip in transcatheter mitral valve repair operation.Mitral average transvalvular pressure gradient and initial p

关 键 词：超声心动描记术 二尖瓣闭锁不全 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]