双导丝技术在瓣周漏介入治疗中的初步应用  

Preliminary clinical application study of the double guidewire technique in interventional treatment of paravalvular leak

作　　者：韩喆 胡海波[1] 吕建华[1] 张辉[3] 黄浩佳[1] 张戈军 徐仲英[1] 潘湘斌[1] HAN Zhe;HU Hai-bo;LÜJian-hua;ZHANG Hui;HUANG Hao-jia;ZHANG Ge-jun;XU Zhong-ying;PAN Xiang-bin(Center of Structural Heart Disease,Fuwai Hospital,Chinese Academy of Medical Sciences,Peking Union Medical College,National Center for Cardiovascular Disease,Beijing 100037,China)

机构地区：[1]国家心血管病中心,北京协和医学院,中国医学科学院阜外医院结构性心脏病中心,北京100037 [2]河北大学附属医院心外科 [3]兰州大学第二医院核磁共振科

出　　处：《中国介入心脏病学杂志》2022年第8期580-584,共5页Chinese Journal of Interventional Cardiology

基　　金：中国医学科学院医学与健康科技创新工程临床与转化医学研究基金项目(2020-I2MC&T-B-062);首都临床特色诊疗技术研究与转化应用专项基金项目(Z201100005520075)。

摘　　要：目的 探讨改良双导丝技术在人工心脏瓣膜置换术后瓣周漏介入治疗中的初步临床应用价值。方法 纳入2017年8月至2019年9月在中国医学科学院阜外医院采用改良双导丝技术进行瓣周漏介入封堵的12例患者。所有患者于术后1个月、3个月、6个月在门诊随访,复查超声心动图、心电图、X线胸片,评估心功能变化。结果 12例瓣周漏患者包括二尖瓣瓣周漏5例,主动脉瓣瓣周漏7例。所有患者均完成瓣周漏介入封堵操作,介入技术成功率100%(12/12)。瓣周漏严重程度分级由术前的(2.42±0.52)级降至术后的(0.67±0.65)级(P<0.001);纽约心脏病协会心功能分级由术前的(3.33±0.65)级降至术后的(2.08±0.67)级(P<0.001)。2例患者术后出现新发溶血伴肾功能不全,经透析治疗后顺利出院;余患者无严重并发症发生。结论 改良双导丝技术应用于瓣周漏的介入治疗是安全有效的,可减少瓣周漏介入术后残余分流、缩短手术时间、减少瓣周组织损伤及围术期并发症发生,但目前临床应用病例数有限,远期疗效尚需进一步研究。Objective To analyze and investigate the preliminary clinical application of the double guidewire technique in interventional therapy of paravalvular leak(PVL)after prosthetic heart valve replacement. Methods From August 2017 to September 2019,12 patients with PVL underwent interventional therapy using the modifi ed double guidewire technique in our hospital. All patients underwent percutaneous interventional PVL closure under local anesthesia,and the modifi ed double guidewire technique was used during all the operations. At 1 month,3 months, and 6 months after the operation,the patients were followed up in an outpatient clinic to review echocardiography,electrocardiogram, chest radiograph,and assess improvement in cardiac function. Results The 12cases of PVL included 5 cases of mitral valve PVL and 7 cases of aortic PVL. All patients completed the interventional occlusion of PVL. The success rate of interventional technology was 100%(12/12). PVL grade decreased from(2.42±0.52)preoperatively to(0.67±0.65)postoperatively (P<0.001). Cardiac function grade(NYHA grade): decreased from(3.33±0.65) preoperatively to(2.08±0.67)postoperatively(P<0.001). In addition, two patients with mitral PVL developed hemolysis with renal insuffi ciency on the second postoperative day and was discharged after dialysis. The remaining patients had no serious complications. Conclusions The double guidewire technique is safe and eff ective for the interventional treatment of PVL, and has some potential advantages in shortening the operation time, reducing paravalvular tissue injury and perioperative complications, but the number of clinical cases is limited, and the long-term effi cacy needs further study.

关 键 词：瓣周漏 双导丝 介入治疗 

分 类 号：R542.5[医药卫生—心血管疾病]