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经胸及经食管超声心动图在经心尖二尖瓣夹合术中的临床应用

Clinical role of transthoracic and transesophageal echocardiography in transapical mitral valve repair
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摘要 目的评价经胸超声心动图(TTE)和经食管超声心动图(TEE)在新型二尖瓣钳夹夹合器(ValveClamp)术中及术后随访的应用,初步验证ValveClamp临床应用的安全性和有效性。方法筛选经临床与TTE及TEE检查诊断为中重度及以上二尖瓣反流的患者6例,在TTE及TEE的引导下分别对患者施行ValveClamp植入术,并于出院时和术后30 d行TTE随访。超声心动图主要观察指标包括二尖瓣最大反流面积(MRA-max)、反流颈宽度(VCW)、二尖瓣有效瓣口面积(MVEOA)、最大跨瓣压差(MVPG-max)及平均跨瓣压差(MVPG-mean)。结果 6例患者均成功接受1枚ValveClamp植入,术后30 d内随访反流均在轻度及以下,且未出现相关并发症。夹合术后,MRA-max、VCW、MVEOA显著减少(均P=0.000),但术后即刻至术后30 d内无显著变化(均P>0.05);MVPG-max、MVPG-mean在术后30 d较植入术前显著升高(均P<0.01),但MVPG-mean均<5 mmHg (1 mmHg=0.133 kPa)。术后30 d左心房前后径较术前显著减小(P<0.05),余超声心动图参数无显著变化(均P<0.05)。结论 ValveClamp对于退行性二尖瓣反流患者能安全、有效、即刻降低反流量;TTE及TEE是ValveClamp术前病例选择、术中导航、术后评价的重要手段。 Objective To evaluate the role of transthoracic echocardiography(TTE) and transesophageal echocardiography(TEE) in the process of transapical mitral valve repair using a novel edge-to-edge device(ValveClamp) and this device′s efficacy and safety in a preliminary clinical trial. Methods Six patients with moderate to severe or severe degenerative mitral regurgitation (DMR) confirmed by TTE and TEE were enrolled. TTE was performed pre and post procedure as well as 30 days post procedures.Related cardiac structure and hemodynamic parameters, including mitral regurgitation area(MRA-max), vena contracta width(VCW), mitral valve effective orifice area(MVEOA), left ventricular end diastolic diameter(LVEDD), left ventricular end systolic diameter(LVESD), left ventricular ejection fraction(LVEF), max and mean mitral valve pressure gradient(MVPG-max and MVPG-mean) were recorded and evaluated in a central core laboratory. Results All the procedures were successfully performed.MRA-max, VCW and MVEOA decreased significantly post procedures (all P<0.000), and they remained no significant changes within 30 days post procedures (all P>0.05). Meanwhile, MVPG-max and MVPG-mean slightly increased (all P<0.01) and left atrial anterior-posterior dimension attenuated 30 days post procedures(P<0.05), but all MVPG-mean were lower than 5 mmHg(1 mmHg=0.133 kPa). There were no significant changes in other hemodynamic parameters (all P>0.05). Conclusions Transapical mitral valve repair using ValveClamp can be performed safely and a significant reduction in mitral regurgitation can be achieved in patients with DMR. TEE and TTE facilitate the patient selection for ValveClamp procedures as well as perioperative navigation and assessment.
作者 葛振一 潘翠珍 李伟 陈海燕 孔德红 周达新 潘文志 魏来 郭克芳 葛均波 舒先红 Ge Zhenyi;Pan Cuizhen;Li Wei;Chen Haiyan;Kong Dehong;Zhou Daxin;Pan Wenzhi;Wei Lai;Guo Kefang;Ge Junbo;Shu Xianhong(Department of Echocardiography, Zhongshan Hospital of Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Shanghai 200032, China;Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China;Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China;Department of Anesthesiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China)
出处 《中华超声影像学杂志》 CSCD 北大核心 2019年第5期382-386,共5页 Chinese Journal of Ultrasonography
基金 上海自然科学基金(18ZR1436100).
关键词 超声心动描记术 经胸 超声心动描记术 经食管 经导管二尖瓣修复术 二尖瓣反流 Echocardiography, transthoracic Echocardiography, transesophageal Transcatheter mitral valve repair Mitral regurgitation
作者简介 通信作者:舒先红,Email:shu.xianhong@zs-hospital.sh.cn.
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