左心室辅助装置支持下单纯收缩期主动脉瓣反流的超声心动图特征  

Echocardioimagedata features of solo-systolic aortic regurgitation during left ventricular assist device support

作　　者：任书堂[1] 刘晓程[2] 张亚东[1] 孙佳英[1] 陈萍[1] 周建华[1] 龙进[1] 黄云洲[1] Ren Shutang;Liu Xiaocheng;Zhang Yadong;Sun Jiaying;Chen Ping;Zhou Jianhud;Long Jin;Huang Yunzhou(Department of Ultrasound,TEDA International Cardiovascular Hospital,Tianjin 300457,China;Department of Cardiac surgery,TEDA International Cardiovascular Hospital,Tianjin 300457,China)

机构地区：[1]泰达国际心血管病医院超声科,天津300457 [2]泰达国际心血管病医院心脏外科,天津300457

出　　处：《中华医学超声杂志（电子版）》2023年第10期1023-1028,共6页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：天津市自然科学基金重点项目(18JCZDJC36200);国家重点研发计划课题(2017YFC0111005)。

摘　　要：目的分析连续流左心室辅助装置(CF-LVAD)植入术后患者出现单纯收缩期主动脉瓣反流(SSAR)的超声心动图特征,探讨其机制及临床意义。方法回顾性分析2019年3月至2022年6月在泰达国际心血管病医院植入CF-LVAD的4例SSAR患者的临床和超声影像学资料。所有患者在LVAD植入前均接受经胸超声心动图(TTE),植入术中和围术期接受经食管超声心动图(TEE),并在植入后定期进行TTE随访,测量和分析其主动脉根部直径以及主动脉瓣开放、反流持续时间和缩流宽度。结果LVAD植入后,超声心动图显示左心室卸载导致的室间隔同向运动及二尖瓣环室间隔侧组织运动速度显著减低或反向。主动脉瓣环和主动脉窦直径均较术前增加。主动脉瓣呈持续性关闭或间歇性开放。主动脉瓣环伴随着心动周期呈现动态变化,收缩期扩张,舒张期回缩。4例患者出现微量至少量的SSAR。随访结果显示,3例SSAR为一过性或无显著变化,1例恶化为重度主动脉瓣关闭不全。结论LVAD植入后SSAR是一种少见的、既往被忽视的血流动力学征象,与LVAD支持下左心室卸载及跨主动脉瓣逆压力梯度有关。SSAR可能是CF-LVAD特殊病理生理学导致的主动脉瓣早期可逆性病变的标志之一。Objective To analyze the echocardioimagedata features of solo-systolic aortic regurgitation(SSAR)after continuous flow(CF)left ventricular assist device(LVAD)implantation to approach its mechanisms and clinical significance.Methods We retrospectively identified four patients with SSAR after CF-LVAD implantation at TEDA International Cardiovascular Hospital from March 2019 to June 2022.Pre-operative transthoracic echocardiography(TTE),intra-and post-operative transesophageal echocardiography(TEE),and follow-up TTE were performed in all patients.The aortic root dimensions,aortic valvular opening,aortic regurgitation duration,and vena contracta(VC)width were measured and analyzed.Results Post-implantation TTE revealed ventricular septal paradoxical motion due to the unloading of the left ventricle,whereas the septum slightly bowed towards the left ventricle during diastole.The systolic velocity of mitral annulus motion became significantly reduced or negative.The aortic valve consistently closed or intermittently opened.The diameter of the aortic annulus and aortic sinus slightly increased.The morphology of the aortic annulus changed throughout the cycles,with the AV annulus abnormally distorted and dilated during systole.SSAR occurred in four cases(16.7%),graded as minimal or mild.Subsequent follow-up results showed that SSAR was transient or unchanged in three cases and was worsening in one case.Conclusion SSSAR post-LVAD implantation is a peculiar and previously neglected hemodynamic sign,which relates to left ventricular unloading and reversed transaortic pressure gradient resulting from LVAD support.SSAR may serve as s surrogate for early reversible aortic valve lesions owing to the special pathophysiology of CF-LVAD.

关 键 词：超声心动描记术 左心室辅助装置 主动脉瓣反流 单纯收缩期 

分 类 号：R540.45[医药卫生—心血管疾病] R542.52[医药卫生—内科学]