超声心动图评估重度主动脉瓣狭窄介入和外科治疗近期效果  

Echocardiography evaluation of the short-term efficacy of interventional and surgical treatment for severe aortic valve stenosis

作　　者：程伟 张滢滢 夏琴 胡娇娇 姚晓静 方靖琴 CHENG Wei;ZHANG Yingying;XIA Qin;HU Jiaojiao;YAO Xiaojing;FANG Jingqin(Department of Ultrasound Diagnosis,Daping Hospital,Army Military Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院超声诊断科,重庆400042

出　　处：《介入放射学杂志》2024年第5期479-482,共4页Journal of Interventional Radiology

基　　金：重庆市科卫联合医学科研项目(2018ZDXM003)。

摘　　要：目的评价超声心动图指标评估重度主动脉瓣狭窄(AS)患者经导管主动脉瓣置换术(TAVR)和外科主动脉瓣置换术(SAVR)治疗的近期效果。方法回顾性分析2019年6月至2022年9月在陆军军医大学大坪医院接受治疗的70例重度AS患者,其中SAVR组40例,TAVR组30例。比较术前1周内及术后1个月超声心动图检查指标。结果两组术后1个月主动脉瓣最大跨瓣流速(Vmax)、主动脉瓣平均跨瓣压差(mPG)、室壁相对厚度(RWT)和左心室质量指数(LVMI)均较术前下降,左心室射血分数(LVEF)较术前升高(均P<0.05)。TAVR组术后LVEF、LVMI和瓣周漏发生率高于SAVR组,Vmax和mPG低于SAVR组(均P<0.05)。对比同组手术前后二尖瓣、三尖瓣中度以上反流,TAVR组由12例(40.0%)降至2例(6.7%)、7例(23.3%)降至1例(3.3%)(均P<0.05),SAVR组由15例(37.5%)降至2例(5.0%)、9例(22.5%)降至1例(2.5%)(均P<0.05);肺动脉高压,TAVR组由17例(56.7%)降至4例(13.3%),SAVR组由22例(55.0%)降至5例(12.5%)(均P<0.05)。但两组间差异无统计学意义(均P>0.05)。结论TAVR和SAVR在改善重度AS所致继发性二尖瓣、三尖瓣反流及肺动脉高压方面疗效相当。TAVR术后心室逆重构和血流动力学改善优于SAVR,但术后瓣周漏发生率高于SAVR。Objective To discuss the clinical value of echocardiographic indicators in assessing the short-term efficacy of transcatheter aortic valve replacement(TAVR)and surgical aortic valve replacement(SAVR)in treating patients with severe aortic valve stenosis(AS).Methods The clinical data of 70 patients with severe AS,who received treatment at the Daping Hospital of Army Military Medical University of China between June 2019 and September 2022 were retrospectively analyzed.The patients were divided into SAVR group(n=40)and TAVR group(n=30).The preoperative one-week and postoperative one-month echocardiographic indicators were compared between the two groups.Results In both groups,the postoperative one-month peak aortic valve velocity(Vmax),aortic valve mean transvalvular pressure gradient(mPG),relative thickness of chamber wall(RWT),and left ventricular mass index(LVMI)were decreased when compared with preoperative values(all P<0.05);in TAVR group the left ventricular ejection fraction(LVEF),LVMI and incidence of perivalvular leakage were remarkably higher than those in SAVR group,while the Vmax and mPG were obviously lower than those in SAVR group(all P<0.05).In TAVR group,the mitral regurgitation decreased from preoperative 12 patients(40%)to postoperative 2 patients(6.7%)and the over-moderate tricuspid regurgitation decreased from preoperative 7 patients(23.3%)to postoperative one patient(3.3%)(all P<0.05).In SAVR group,the mitral regurgitation decreased from preoperative 15 patients(37.5%)to postoperative 2 patients(5.0%)and the over-moderate tricuspid regurgitation decreased from preoperative 9 patients(22.5%)to postoperative one patient(2.5%)(all P<0.05).The pulmonary artery hypertension in TAVR group decreased from preoperative 17 patients(56.7%)to postoperative 4 patients(13.3%),which in SAVR group decreased from preoperative 22 patients(55.0%)to postoperative 5 patients(12.5%)(P<0.05),but the differences in the above indexes between the two groups were not statistically significant(all P>0.05).Conclusion TAVR

关 键 词：经导管主动脉瓣置换术 外科主动脉瓣置换术 重度主动脉瓣狭窄 超声指标 近期疗效 

分 类 号：R654.2[医药卫生—外科学]