单纯经食管超声心动图引导经胸小切口封堵人工瓣膜瓣周漏  

Feasibility of Paravalvular Leak Occlusion via Mini-Thoracotomy by Transesophageal Echocardiography Guidance

作　　者：郭方舟[1] 叶娜[1] 陈昆迪 刘学会[1] 杨绍庆 李静[1] 王小锋[1] Guo Fangzhou;Ye Na;Chen Kundi;Liu Xuehui;Yang Shaoqing;Li Jing;Wang Xiaofeng(Ultrasound Medical Center of Lanzhou University Second Hospital,Lanzhou 730000.China)

机构地区：[1]兰州大学第二医院超声医学中心,兰州市730000

出　　处：《中国超声医学杂志》2022年第6期711-714,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨经食管超声心动图(TEE)引导经胸小切口封堵人工瓣膜瓣周漏的安全性和有效性。方法选取兰州大学第二医院心脏瓣膜置换术后并发瓣周漏患者5例,术前经胸超声心动图(TTE)评估瓣周漏的位置和大小,术中TEE再次测量瓣周漏的位置、大小及形状,并准确引导导丝及鞘管穿过瓣周漏,指导封堵器的释放,术后TEE评估封堵器位置及人工瓣膜的启闭运动,并进行随访。结果2例主动脉瓣瓣周漏位于无冠瓣瓣周,3例二尖瓣瓣周漏中1例位于后瓣瓣周,2例位于前瓣瓣周,封堵器置入后,瓣周分流即刻消失,人工瓣膜启闭运动未受影响,运动正常,术后3 d复查TTE,封堵器位置均正常,未见明显残余分流,左室较术前减小,心功能正常。术后多次复查TTE,封堵器位置均正常,人工瓣膜启闭运动正常,未见残余分流,心功能正常。结论TEE引导经胸小切口封堵人工瓣膜瓣周漏不仅安全、有效,创伤小,费用低,而且避免X线辐射和造影剂。Objective To explore the safety and efficacy of transesophageal echocardiography(TEE)guided transthoracic approach paravalvular leak(PVL)closure.Methods Five patients with PVL after surgical valve replacement were selected from Lanzhou University Second Hospital.Transthoracic echocardiography(TTE)were used to assess the location and size of PVL for preoperative evaluation.And intraoperative TEE were used to remeasure the location,size,and shape of the PVL and to guide the wire and sheath passing the PVL accurately,and to guide the occluder releasing.Postoperative TEE were used to assess the position of the occluder and the motion of the prosthetic valves and also used in follow up.Results Two patients of aortic PVL were located in the noncoronary sinus area.In the three patients of mitral PVL,one was located in posterior leaflet area,and two were located in anterior leaflet area.The paravalvular shunt disappeared immediately after the insertion of the occluder,and the motion of the prosthetic valves were not affected and the motion were normal.The reexamination of TTE 3 days after the surgery showed that the position of all occluders were normal,no obvious residual shunt were found,and the left ventricle of patients were smaller than preoperation,and the cardiac function were normal.Repeated postoperative reexaminations showed that all occluders position were normal,and the motion of prosthetic valves were normal too,no residual shunt were found,the cardiac function were normal.Conclusions TEE guided transthoracic approach PVL closure is safe,effective,small trauma,and low cost,and it could avoid X-ray radiation and contrast agents.

关 键 词：食管超声心动图 瓣周漏 介入封堵 

分 类 号：R540.45[医药卫生—心血管疾病] R654.2[医药卫生—内科学]