经导管血管塞封堵瓣膜术后瓣周漏临床分析  

Interventional treatment of paravalvular regurgitation by vascular plug implantation following prosthetic valve replacement

作　　者：杨惠 王静[2] 秦丫红 赵帆 褚嫒嫒[2] Yang Hui;Wang Jing;Qin Ya-hong;Zhao Fan;Chu Ai-ai(Department of Cardiology,Guangzhou Red Cross Hospital Affiliated Jinan University,Guangzhou 510200,China;Department of Cardiology,Gansu Provincial Hospital,Lanzhou 730030,China)

机构地区：[1]暨南大学附属广州红十字会医院心内科,广东广州510200 [2]甘肃省人民医院心内科,甘肃兰州730000

出　　处：《兰州大学学报（医学版）》2022年第2期48-51,57,共5页Journal of Lanzhou University（Medical Sciences）

基　　金：甘肃省自然科学基金资助项目(21JR7RA604);甘肃省人民医院院内培育基金资助项目(19SYPYB-20)。

摘　　要：目的 探讨经导管血管塞封堵外科高危人工瓣膜置换术后瓣周漏(PVL)单中心经验。方法 回顾性分析2017年6月-2020年8月在甘肃省人民医院完成经导管介入治疗人工瓣膜置换术后PVL患者10例,并完成中期随访。患者术前均经超声心动图诊断,并记录手术成功率、并发症和相关心血管事件。结果 住院期间发生与PVL封堵相关主要并发症为1例术后溶血加重,1例穿刺部位血肿。患者平均随访1 a,临床心功能得到改善,NYHA心功能分级从2.8降低至1.5 (P<0.05),超声心动图结果提示手术后左室舒张末和收缩末内径及肺动脉收缩压均较术前明显减小(P<0.05)。结论 经导管介入血管塞封堵器封堵人工瓣膜置换术后PVL在外科高危患者中可替代手术,使患者获益。该方法安全有效,应积累经验。Objective Interventional closure of paravalvular leaks(PVL) by vascular plug implantation has emerged as an alternative to surgical correction, which is associated with a high mortality surgical risk for repeat surgery. Methods From 06/2017 to 08/2020 ten patients from Gansu Provincial Hospital who had been diagnosed by clinical and echocardiographic course underwent interventional PVL closure for paravalvular regurgitation. Procedural details, technical success, intervention-related complications, cardiac events, in-hospital and mid-term outcomes were assessed. Results Complications included device-mediated hemolysis and severe hematoma at the femoral puncture site, which occurred during the perioperative period in 2 cases separately. In the mean 12-months after percutaneous repair, median NYHA class improved significantly from2.8 prior to procedure to 1.5(P < 0.05), there was also a tendency toward a reduction in the left ventricular enddiastolic and end-systolic dimension and systolic pulmonary pressure at the median according to the follow-up by echocardiographic detection(P < 0.05). Conclusion In the single-center series interventional PVL closure appears to be promising for patients at a high surgical risk with symptomatic paravalvular regurgitation. Gaining experience in interventional PVL closure will further improve the safety and efficacy of this relatively new treatment option.

关 键 词：瓣周漏 血管塞 经导管修补 随访 

分 类 号：R542.52[医药卫生—心血管疾病]