经食管超声心动图引导NeoChord人工腱索治疗二尖瓣后叶脱垂合并重度反流的初步研究  

Initial clinical experience with transesophageal echocardiography guided NeoChord system for massive regurgitation of posterior mitral valve prolapse

作　　者：顾婕 蒲朝霞[1] 刘先宝[2] 任凯达 何伟[3] 孔敏坚[4] 王建安[2] Gu Jie;Pu Zhaoxia;Liu Xianbao;Ren Kaida;He Wei;Kong Minjian;Wang Jian′an(Department of Echocardiography,the Second Affiliated Hospital of Zhejiang University,Hangzhou 310009,China;Department of Cardiovascular Medicine,the Second Affiliated Hospital of Zhejiang University,Hangzhou 310009,China;Department of Anesthesiology,the Second Affiliated Hospital of Zhejiang University,Hangzhou 310009,China;Department of Cardiac Vascular Surgery,the Second Affiliated Hospital of Zhejiang University,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院心脏超声中心,杭州310009 [2]浙江大学医学院附属第二医院心血管内科,杭州310009 [3]浙江大学医学院附属第二医院麻醉科,杭州310009 [4]浙江大学医学院附属第二医院心脏大血管外科,杭州310009

出　　处：《中华超声影像学杂志》2020年第5期389-393,共5页Chinese Journal of Ultrasonography

摘　　要：目的:初步探讨经食管超声心动图引导NeoChord人工腱索治疗二尖瓣后叶脱垂合并重度反流的应用价值。方法:选取2019年4-7月浙江大学医学院附属第二医院8例二尖瓣后叶脱垂合并重度反流的NeoChord人工腱索植入术的患者,NeoChord人工腱索植入前经食管超声心动图详细评估二尖瓣形态、脱垂位置及反流程度;植入术中经食管超声全程指导穿刺部位、人工腱索植入路径并调节腱索长度;植入后评估人工腱索位置,评估反流程度的改善情况,且手术全程监测有无并发症的发生。结果:8例患者分别植入人工腱索2~4根,术中即刻经食管超声心动图和出院前经胸超声心动图提示患者术后轻度残余反流5例,中度残余反流2例,轻-中度残余反流1例,术中术后均无并发症发生;术后1个月经胸超声心动图复查示轻度反流6例,中度反流2例。结论:NeoChord人工腱索植入术是二尖瓣脱垂引起的二尖瓣重度反流患者的安全、有效、易操作的治疗方式,经食管超声心动图在人工腱索植入过程中起着重要的指导作用。Objective To explore the evaluation of transesophageal echocardiography(TEE)in patients with massive regurgitation of posterior mitral valve prolapse undergoing transapical off-pump NeoChord repair.Methods Eight patients from April to July 2019 in the Second Affilliated Hospital of Zhejiang Univerity with massive regurgitation of posterior mitral valve prolapse underwent NeoChord repair mitral valve morphology,prolapse position and regurgitation degree were evaluated before NeoChord implantation by TEE.Under TEE guidance,the puncture site was identificated,the position and length of artificial chordae were adjusted during implantation.NeoChord′s function and positon after implantation were observed.The complications were monitored during the operation.Results Mitral valve repair by NeoChord system was successfully performed with implantation of 2 to 4 artificial chordaes in eight patients respectively.Intraoperative TEE and pre-discharge transthoracic echocardiography(TTE)showed moderate MR in two patients,mild to moderate MR in one patient,mild MR in the remaining five patients.Reexaminations with TTE at 1 month after operation showed moderate MR in six patients,and mild to moderate MR in two patients.And no postoperative complications were noted.Conclusions NeoChord system is a safe,effective and feasible treatment method for patient with mitral valve prolapse,TEE plays an important role during NeoChord implantation.

关 键 词：超声心动描记术 经食管 二尖瓣反流 人工腱索 NeoChord系统 

分 类 号：R654.2[医药卫生—外科学] R540.45[医药卫生—临床医学]