左室辅助装置植入前后主动脉瓣反流的超声评价和临床预后  

Value of transthoracic echocardiography to monitor and evaluate aortic insufficiency after implantation of left ventricular assist device

作　　者：施怡声 朱振辉 王浩[1] 杜娟 陈海波 胡盛寿[3] SHI Yisheng;ZHU Zhenhui;WANG Hao;DU Juan;CHEN Haibo;HU Shengshou(Ultrasound Imaging Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China;Postoperative Recovery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China;Adult Cardiac Surgery Center,National Center for Cardiovascular Diseases and Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China)

机构地区：[1]国家心血管病中心中国医学科学院北京协和医学院阜外医院超声影像中心,北京100037 [2]国家心血管病中心中国医学科学院北京协和医学院阜外医院术后恢复中心,北京100037 [3]国家心血管病中心中国医学科学院北京协和医学院阜外医院成人心脏外科中心,北京100037

出　　处：《中国胸心血管外科临床杂志》2021年第6期670-674,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的探讨经胸超声心动图(TTE)监测及评估左室辅助装置(LVAD)植入后1年内主动脉瓣反流(AI)变化的价值。方法回顾性分析2018~2020年在我院行LVAD植入术12例患者的TTE资料,患者均为男性,平均年龄(43.3±8.6)岁。采集并分析LVAD植入前,植入后1个月、3个月、6个月及12个月的主动脉瓣环(AA)、主动脉窦部(AoS)、升主动脉(AAo)、AI量的变化及主动脉瓣的开放情况。结果 12例患者LVAD植入后1年内全部存活。1例植入后第6个月桥接到心脏移植,2例分别于3个月和6个月后未再复查TTE。与植入前相比,植入后1个月AoS增大[术前(31.58±5.09)mm vs.术后第1个月(33.83±4.69)mm],3个月、6个月、12个月AA、AoS、AAo内径均较术前增大(P<0.05),但除1例术前AoS已轻度增大外,其余内径均在正常范围内。术后经LVAD泵速调整,主动脉瓣开放情况改善。植入后第6个月、12个月AI量较术前增加,且第12个月时较第6个月增加(P<0.05)。结论 TTE可在LVAD植入前、后对主动脉瓣的反流进行评估和随访,并可对LVAD泵功能的优化和调整进行监测,可能对LVAD植入后患者的预后产生积极影响。Objective To explore the value of transthoracic echocardiography(TTE)to monitor and evaluate aortic insufficiency(AI)within one year after the implantation of the left ventricular assist device(LVAD).Methods We retrospectively collected and analyzed the TTE data of 12 patients who received LVAD implantation from 2018 to 2020 in our hospital.All patients were males,with an average age of 43.3±8.6 years.We analyzed temporal changes in the aortic annulus(AA),aortic sinus(AoS),ascending aorta(AAo),the severity of AI and the opening of aortic valve before operation and 1 month,3 months,6 months and 12 months after LVAD implantation.Results All 12 patients survived within 1 year after LVAD implantation.One patient was bridged to heart transplantation 6 months after implantation,and two patients did not receive TTE after 3 and 6 months.Compared to pre-implantation,AoS increased at 1 month after implantation(31.58±5.09 mm vs.33.83±4.69 mm).The inner diameters of AA,AoS and AAo increased at 3,6 and 12 months after LVAD implantation compared to pre-implantation(P<0.05),but all were within the normal range except for one patient whose AoS slightly increased before operation.After LVAD pump speed was adjusted,the opening of aortic valve improved.The severity of AI increased at 6 and 12 months after LVAD implantation compared to pre-implantation,and increased at 12 months compared to 6 months after LVAD implantation(P<0.05).Conclusion TTE can evaluate aortic regurgitation before and after LVAD implantation and monitor the optimization and adjustment of LVAD pump function,which has a positive impact on the prognosis after LVAD implantation.

关 键 词：经胸超声心动图 左室辅助装置 主动脉瓣反流 

分 类 号：R540.45[医药卫生—心血管疾病]