外科生物瓣毁损患者使用Venus-A人工瓣膜行经导管主动脉瓣置换术术前CT评估的方法与效果  

CT Imaging Evaluation for Transcatheter Aortic Valve Replacement with Venus-A valve in Bioprosthetic Valve Deteriorated Patients

作　　者：王墨扬[1] 宋光远[1] 张倩[1] 牛冠男[1] 王媛[2] 叶蕴青[1] 罗彤[1] 王巍[1] 吴永健[1] WANG Mo-yang;SONG Guang-yuan;ZHANG Qian;NIU Guan-nan;WANG Yuan;YE Yun-qing;LUO Tong;WANG wei;WU Yong-jian(Structure Heart Disease Center,National Center for Cardiovascular Disease and Fuwai Hospital,CAMS and PUMC,Beijing 100037,China;Department of Cardiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院结构性心脏病中心,100037 [2]首都医科大学附属北京友谊医院心脏内科,100050

出　　处：《中国分子心脏病学杂志》2021年第1期3711-3714,共4页Molecular Cardiology of China

基　　金：中国医学科学院医学与健康科技创新工程项目(2017-I2M-3-002)。

摘　　要：目的探讨术前计算机断层扫描(CT)评估外科主动脉生物瓣环内径中多平面曲线瓣环测量法及三维重建法测量间的差异以及基于CT结果指导外科生物瓣毁损患者使用Venus-A瓣膜行经导管主动脉瓣置换术(TAVR)的有效性及安全性。方法回顾性分析2013年3月至2019年10月连续10例在外科毁损生物瓣中采用Venus-A瓣膜行TAVR患者,通过术前CT扫描图像确认外科瓣膜类型,采用多平面曲线瓣环测量法及三维重建法测量外科瓣膜内径并进行对比,并基于CT结果制定TAVR策略。通过术中即刻效果、术后不良事件及血流动力学指标评估其安全性及有效性。结果患者中男性8例,平均年龄(72.4±5.4)岁,平均心胸外科协会风险评分(7.4±2.1%),外科瓣膜置换术(均为有瓣架生物瓣)后平均(8.0±5.4)年。CT多平面曲线瓣环测量法与三维重建瓣环测量法瓣环内径结果无统计学差异[(20.9±1.8)mm比(20.4±2.1)mm,P=0.438],且均与厂家参数瓣架内径吻合(P>0.05)。所有患者窦部内径、窦管交界内径、瓣膜冠脉距离均符合预防冠脉闭塞解剖结构要求。根据CT测量结果选择TAVR瓣膜型号及扩张策略,术中1例颈动脉路径余经股动脉路径,2例进行球囊预扩张,均顺利植入Venus-A瓣膜,除1例术后残余狭窄外余9例均达到器械成功标准。30天随访1例出现脑出血外余无不良事件,30天超声心动平均主动脉瓣最大流速2.6(2.5,2.8)m/s,平均跨瓣压差13.5(13.0,17.0)mmHg,无中度及以上瓣周反流。术后12个月随访无死亡及致残性卒中发生,超声心动平均主动脉瓣最大流速2.7(2.5,3.1)m/s,平均跨瓣压差15(13.5,21.0)mmHg,无中度及以上瓣周反流。结论术前CT中多平面曲线瓣环测量法及三维重建法均可准确反映毁损瓣膜内径,基于CT评估结果指导外科物瓣毁损患者使用Venus-A人工瓣膜行TAVR早期结果安全有效。Objective To compare the different between the curved multi-planar reconstruction and 3-dimension reconstruction methods to measure the dimensions of the deteriorated surgical bioprosthetic valves and evaluate the role of computed tomography(CT)in transcatheter aortic valve replacement(TAVR)using venus-A valve prosthesis with bioprosthetic valve deteriorated Patients.Methods We retrospectively analyzed 10 consecutive patients with deteriorated surgical bioprosthetic valves who underwent TAVR with the Venus-A valve from March 2013 to October 2019 in Fuwai Hospital.Based on the pre-TAVR CT images,the surgical prosthesis type and size was confirmed.We developed the curved multi-planar reconstruction and 3-dimension reconstruction methods to measure the dimensions of the surgical valve and aortic root.The strategy of TAVR and prothesis size was proposed on the basis of the CT analysis.Results Patients were mainly male(8 cases)and(72.4±5.4)years old with a mean STS score of(7.4±2.1)%.The mean duration of the surgical prosthesis was(8.0±5.4)years.No significant difference was noticed between the diameter by CT and that by multi-planar and 3-dimension reconstruction methods([20.9±1.8]mm vs[20.4±2.1]mm,P=0.438).Both of the measurement results by the multi-planar and 3-dimension reconstruction methods were similar with official prosthesis stent inner diameter([20.9±1.8]mm vs[21.6±1.9]mm,P=0.217;[20.4±2.1]mm vs[21.6±1.9]mm,P=0.178).Sinus diameter,STJ diameter and the distance of valve to coronary artery also meet the standard to prevent coronary obstruction.The choice of the TAVR valve size and ballooning strategy were relied on the CT measurement.Only one patient underwent the transcarotid access while others via the femoral artery.Pre-dilatation was observed in two patients.All of the patients implanted Venus-A valve successfully with one case of Residual stenosis after procedure.There was no adverse event except 1 case with cerebral hemorrhage at 30 days.The 30-day echocardiogram outcome were mean aortic peak v

关 键 词：CT评估 外科生物瓣毁损 经导管主动脉瓣置换术 

分 类 号：R654.2[医药卫生—外科学]