超声心动图用于心尖入路经导管主动脉瓣植入术  

Echocardiography in transapical transcatheter aortic valve implantation

作　　者：范琳 周炳元[1] 苗玉珠[1] 廖玉苹 赵彩明[1] FAN Lin;ZHOU Bingyuan;MIAO Yuzhu;LIAO Yuping;ZHAO Caiming(Department of Cardiology Echocardiography,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院心血管内科心超室,江苏苏州215006

出　　处：《中国医学影像技术》2022年第3期369-373,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的 评价超声心动图用于心尖入路经导管主动脉瓣植入术(TAVI)的价值。方法 纳入23例接受J-Valve TAVI的主动脉瓣疾病患者,根据主要疾病,将其中20例非重度主动脉瓣狭窄(AS)合并中度以上主动脉瓣反流(AR)者分为AS组(n=10)及AR组(n=10)。术前行经胸超声心动图(TTE),术中全程以经食管超声心动图(TEE)引导监测瓣膜植入,术后即刻评估手术疗效及并发症;术后2周复查TTE,评估心脏及人工瓣功能和并发症。结果 23例中,6例(6/23,26.09%)左心室射血分数(LVEF)<50%,18例(18/23,78.26%)左心房前后径(LAD)增大,11例(11/23,47.83%)左心室舒张末期内径(LVEDD)增大。AS组LVEDD、左心室收缩末期内径(LVESD)及主动脉瓣口面积明显小于AR组(P均<0.05);AS组主动脉瓣口峰值流速及主动脉瓣口跨瓣压差明显高于AR组(P均<0.05)。术后即刻23例人工瓣口跨瓣压差均明显下降,9例(9/23,39.13%)出现轻度及以上瓣周漏。术后22例LAD、LVEDD、LVEF、人工瓣口峰值流速及人工瓣口跨瓣压差较术前均明显减低(P均<0.05),未见感染性心内膜炎等严重并发症;1例死亡。组间术后LVEDD、LVESD及LVEF差异均有统计学意义(P均<0.05);AS组术后主动脉瓣口峰值流速及跨瓣压差较术前均明显降低(P均<0.05);AR组术后LVEDD、LVEF、每搏量、心排血量及心指数较术前均明显降低(P均<0.05)。结论 超声心动图对于术前筛选心尖入路TAVI适应证、术中引导操作、术后评估及随访均具有重要作用。Objective To observe the value of echocardiography for transapical transcatheter aortic valve implantation(TAVI). Methods Totally 23 aortic valve lesions patients who underwent TAVI with J-Valve were enrolled. Twenty patients without severe aortic stenosis(AS) complicated with median or high degree aortic regurgitation(AR) were divided into AS group and AR group(each n=10) according to the main lesions. Transthoracic echocardiography(TTE)was performed before operation, while transesophageal echocardiography(TEE) was used to guide the operation, evaluate the therapeutic results and complications immediately after implantation of aortic valve. TTE was reexamined 2 weeks after operation to assess the function of heart, aortic valve and complications. Results Among 23 patients, left ventricular ejection fraction(LVEF) lower than 50% was detected in 6 cases(6/23, 26.09%), left atrial diameter(LAD) increased in 18 cases(18/23, 78.26%), while ventricular end-diastolic diameter(LVEDD) increased in 11 cases(11/23, 47.83%). LVEDD, left ventricular end-systolic diameter(LVESD) and aortic orifice area in AS group were all significantly smaller than those in AR group(all P<0.05), while the peak aortic valve orifice velocity and transvalvular gradients of aortic valve orifice in AS group were significantly higher than those in AR group(both P<0.05). After operation, the transvalvular gradients of artificial aortic valve orifice of all 23 patients descended evidently, meanwhile, mild or severe perivalvular leakage were found in 9 cases(9/23, 39.13%). Significant decreased postoperational LAD, LVEDD, LVEF, artificial peak aortic valve orifice velocity and transvalvular gradients of artificial aortic valve orifice were observed in 22 patients(all P<0.05), but no serious complication occurred, while 1 patient died 6 days after operation. There were significant differences of LVEDD, LVESD and LVEF between AS group and AR group after operation(all P<0.05). After operation, the peak aortic valve orifice velocity and transvalvular gra

关 键 词：经导管主动脉瓣置换术 超声心动描记术 

分 类 号：R542.5[医药卫生—心血管疾病] R540.45[医药卫生—内科学]