| 摘要: |
| 目的 利用二维超声心动图监测并分析经导管主动脉瓣置入术（TAVI）术后早期患者心脏形态及功能状态。方法 选择2017年12月至2019年12月在我院心血管外科就诊并行TAVI的33例患者，收集患者年龄、性别、NYHA心功能分级、既往心脏外科手术史、美国胸外科医师学会（STS）评分、手术入路、并发疾病等基本资料，以及术前和术后早期（0~2个月）超声心动图检查数据。结果 33例患者中重度主动脉瓣狭窄（SAS）组20例，重度主动脉瓣反流（SAR）组8例，SAS合并SAR组（合并组）5例。术后早期SAS组1例患者2次因心律失常加重心力衰竭再次住院治疗，4例患者出现微量瓣周漏，1例患者出现大量瓣周漏；SAR组1例患者出现中度瓣周漏；合并组1例患者出现轻度瓣周漏。与术前相比，术后早期33例患者总体左心室舒张末期容积（LVEDV）、左心房容积（LAV）、最大主动脉瓣跨瓣压差（AVPGmax）均下降（P均<0.01），主动脉瓣有效瓣口面积（AVA）增加（P<0.01），左心室射血分数（LVEF）、室间隔厚度（IVST）、后壁厚度（PWT）均未发生明显变化（P均>0.05）；SAS组LVEF升高（P<0.05），LAV、AVPGmax均下降（P<0.05，P<0.01），AVA增加（P<0.01）；SAR组LVEDV、LAV均下降（P均<0.01），IVST增加（P<0.05）；合并组LVEDV、LAV、AVPGmax均下降（P均<0.05），AVA增加（P<0.01）。结论 对于SAS、SAR和SAS合并SAR患者，TAVI术后早期心脏逆重构、收缩功能均有不同程度改善。单纯SAR及合并SAS的高危患者可从TAVI获益。 |
| 关键词: 经导管主动脉瓣置入术 主动脉瓣狭窄 主动脉瓣关闭不全 超声心动描记术 左心形态 左心室收缩功能 |
| DOI：10.16781/j.0258-879x.2020.08.0864 |
| 投稿时间：2020-01-26修订日期：2020-03-31 |
| 基金项目:国家重点研发计划（2016YFC1100900）． |
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| Two-dimensional echocardiography in evaluating left ventricular morphology and systolic function at early stage after transcatheter aortic valve implantation |
| ZHOU Guang-wei△,LI Ning△,FEI Xiang,QIAO Fan,SONG Zhi-gang,LU Fang-lin*,XU Zhi-yun |
(Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To monitor and analyze the cardiac morphology and functional status at early stage after transcatheter aortic valve implantation (TAVI) by two-dimensional echocardiography. Methods A total of 33 patients with TAVI were selected from Dec. 2017 to Dec. 2019 in the Department of Cardiovascular Surgery of our hospital. The age, gender, New York Heart Association (NYHA) cardiac function classification, previous cardiac surgery history, Society of Thoracic Surgeons (STS) score, surgical approach, complication, other basic data, as well as echocardiography data were collected before and after TAVI (0-2 months). Results Thirty-three patients met the inclusion criteria, including 20 patients with severe aortic stenosis (SAS group), eight patients with severe aortic regurgitation (SAR group), and five patients with SAS combined with SAR (combined group). In the early postoperative period, one patient in SAS group was hospitalized twice for heart failure aggravated by arrhythmia, four patients in SAS group had tiny perivalvular leakage and one patient had large perivalvular leakage; moderate perivalvular leakage occurred in one patient in SAR group, and mild perivalvular leakage occurred in one patient in the combined group. Compared with the preoperative values, early after operation 33 cases had decreased left ventricular end-diastolic volume (LVEDV), left atrial volume (LAV), and maximum aortic valve pressure gradient (AVPGmax), increased effective aortic valve area (AVA) (all P<0.01), and unchanged left ventricular ejection fraction (LVEF), interventricular septum thickness (IVST), and posterior wall thickness (PWT) significantly (all P>0.05). In SAS group, LVEF and AVA increased, while LAV and AVPGmax decreased significantly (P<0.05 or P<0.01). In SAR group, LVEDV and LAV decreased, while IVST increased significantly (P<0.05 or P<0.01). In combined group, LVEDV, LAV and AVPGmax decreased, while AVA increased significantly (P<0.05 or P<0.01). Conclusion Early after TAVI, the cardiac remodeling and systolic function are improved to different degrees in patients with SAS, SAR, and SAS combined with SAR. High risk patients with SAR alone or combined with SAS can benefit from TAVI. |
| Key words: transcatheter aortic valve implantation aortic valve stenosis aortic valve insufficiency echocardiography left heart morphology left ventricular systolic function |
