超声心动图在经心尖主动脉瓣人工瓣膜植入术治疗主动脉瓣狭窄患者中的应用价值

doi:10.3877/cma.j.issn.1672-6448.2017.03.005

目的

探讨超声心动图在经心尖主动脉瓣人工瓣膜植入术（TAAVI）治疗主动脉瓣狭窄患者中的应用价值。

方法

选择2014年6月至2015年3月中国医学科学院阜外心血管病医院收治的接受TAAVI治疗的15例重度主动脉瓣狭窄患者。分别于术前、出院时、术后1个月、术后3~6个月采用超声心动图评估左心室舒张末内径、左心房内径及左心室射血分数、主动脉有效瓣口面积、平均跨瓣压差。采用单因素方差分析分别比较术前、出院时、术后1个月、术后3~6个月患者左心室舒张末期内径、左心房内径、左心室射血分数、主动脉瓣有效瓣口面积、平均跨瓣压差，进一步组间两两比较采用LSD-t检验。

结果

入选15例患者术前超声心动图显示为重度主动脉瓣狭窄，平均有效瓣口面积（0.55±0.28）cm²，术前平均跨瓣压差为（58.93±14.96）mmHg（1 mmHg=0.133 kPa）。1例患者术中超声示中量瓣周漏，重新放置瓣膜顺利。出院时、术后1个月、术后3~6个月患者左心室舒张末内径、左心房内径及左心室射血分数与术前比较差异均无统计学意义。除1例患者其他原因死亡外，术后超声随访结果示所有患者人工瓣膜位置均正常，7例患者探及瓣周1~2 mm反流。与术前比较，患者出院时及术后1个月、术后3~6个月主动脉瓣有效瓣口面积均增加，平均跨瓣压差均下降，且差异均有统计学意义（t=6.619、7.357、6.401，P均<0.001；t=9.523、9.687、5.932，P均<0.001）。

结论

术前经过超声心动图严格筛选，TAAVI治疗严重主动脉瓣狭窄患者效果良好。超声心动图在术中评估及术后随访中具有非常重要作用。

关键词: 超声心动描记术, 主动脉瓣狭窄, 经心尖主动脉瓣人工瓣膜植入术

Objective

To explore the value of echocardiography in patients with aortic stenosis who underwent transapical aortic valve implantation (TAAVI).

Methods

Fifteen high-risk patients with severe aortic stenosis were chosen in the present study, all of which received TAAVI in Fuwai Hospital Chinese Academy of Medical Sciences from June 2014 to March 2015. The left ventricular end-diastolic diameter (LVEDD), left atrial diameter (LAD), left ventricular ejection fraction (LVEF), effective orifice area (EOA), mean aortic pressure gradient (MPG), as well as artificial valve function of patients were measured at different time points (before operation, discharge, 1 month and 3-6 months after operation) by echocardiography. The data were analyzed using one-way ANOVA analysis with SPSS software, and multiple comparisons were done using LSD student t test.

Results

The data from preoperative echocardiography indicated severe aortic stenosis in the 15 patients, with the average level of EOA as (0.55±0.28) cm² and MPG as (58.93±14.96) mmHg (1 mmHg=0.133 kPa). Moderate paravalvular aortic regurgitation was observed in one patients, who was then received a second implantation. There was no significant difference between LVEDD, LAD, and LVEF when the patients were at discharge, 1 month and 3-6 months after operation. The prosthetic valves were stable and conformed by echocardiography, while paravalvular leak regurgitation (1-2 mm) was observed in 7 patients. One patient died of other reasons. Compared with preoperative data, the EOA increased while MPG decreased when the patients were at discharge, 1 month and 3-6 month after operation (t=6.619, 7.357, 6.401, all P<0.001; t=9.523, 9.687, 5.932, all P<0.001).

Conclusion

With careful patient screening and selection, TAAVI can be an effective treatment for high-risk severe aortic stenosis patients, in which echocardiography plays an important role during the surgery and follow up.

Key words: Echocardiagraphy, Aortic stenosis, Transapical aortic valve implantation

图2 经食管超声心动图主动脉短轴示主动脉瓣呈二叶，瓣叶增厚、钙化，开放受限

图4，5 经胸超声心动图左心室长轴（图4）及主动脉短轴（图5）示人工瓣瓣周1~2 mm少量反流

表1 患者术前及术后超声心动图观察指标比较（±s）

时间	例数	左心室舒张末期内径（mm）	左心房内径（mm）	左心室射血分数（%）	主动脉瓣有效瓣口面积（cm²）	平均跨瓣压差（mmHg）
术前	15	48.30±8.21	38.73±5.09	60.80±11.25	0.55±0.28^a	58.9±14.96^b
出院时	15	49.07±7.05	37.60±5.33	66.16±7.58	1.37±0.29	20.07±8.61
术后1个月	15	47.92±6.39	31.50±3.78	62.66±6.19	1.37±0.58	17.0±8.47
术后3~6个月	14	50.33±2.31	35.33±3.06	57.80±5.63	1.34±0.64	17.0±8.89
F值	?	0.123	0.715	1.357	12.306	43.739
P值	?	0.946	0.549	0.296	<0.001	<0.001

表1 患者术前及术后超声心动图观察指标比较（±s）

时间	例数	左心室舒张末期内径（mm）	左心房内径（mm）	左心室射血分数（%）	主动脉瓣有效瓣口面积（cm²）	平均跨瓣压差（mmHg）
术前	15	48.30±8.21	38.73±5.09	60.80±11.25	0.55±0.28^a	58.9±14.96^b
出院时	15	49.07±7.05	37.60±5.33	66.16±7.58	1.37±0.29	20.07±8.61
术后1个月	15	47.92±6.39	31.50±3.78	62.66±6.19	1.37±0.58	17.0±8.47
术后3~6个月	14	50.33±2.31	35.33±3.06	57.80±5.63	1.34±0.64	17.0±8.89
F值	?	0.123	0.715	1.357	12.306	43.739
P值	?	0.946	0.549	0.296	<0.001	<0.001

[1]	Jayasuriya C, Moss RR, Munt B. Transcatheter aortic valve implantation in aortic stenosis: the role of echocardiography [J]. J Am Soc Echocardiogr, 2011, 24(1):15-27.
[2]	Seco M, Martinez G, Bannon PG, et al. Transapical aortic valve implantation-an Australian experience [J]. Heart Lung Circ, 2014, 23(5):462-468.
[3]	Schoon Y. Is transcatheter aortic valve implantation superior to surgical valve replacement? [J]. Ned Tijdschr Geneeskd, 2016, 160(0):D905.
[4]	Malaisrie SC, Barnhart GR, Farivar RS, et al. Current era minimally invasive aortic valve replacement: techniques and practice [J]. J Thorac Cardiovasc Surg, 2014, 147(1):6-14.
[5]	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [J]. J Am Coll Cardiol, 2014, 63(22):2438-2488.
[6]	Zamorano JL, Badano LP, Bruce C, et al. EAE/ASE recommendations for the use of echocardiography in new transcatheter interventions for valvular heart disease [J]. Eur Heart J, 2011, 32(17):2189-2214.
[7]	Leon MB, Piazza N, Nikolsky E, et al. Standardized endpoint definitions for transcatheter aortic valve implantation clinical trials: a consensus report from the Valve Academic Research Consortium [J]. Eur Heart J, 2011, 32(2):205-217.
[8]	Cribier A, Eltchaninoff H, Bash A, et al. Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description [J]. Circulation, 2002, 106(24):3006-3008.
[9]	Genereux P, Head SJ, Wood DA, et al. Transcatheter aortic valve implantation 10-year anniversary: review of current evidence and clinical implications [J]. Eur Heart J, 2012, 33(19):2388-2398.
[10]	Kempfert J, Meyer A, Kim WK, et al. Comparison of two valve systems for transapical aortic valve implantation: a propensity score-matched analysis [J]. Eur J Cardiothorac Surg, 2016, 49(2):486-492.
[11]	Van Linden A, Doss M, Arsalan M, et al. Transcatheter aortic valve implantation--update and evidence [J]. Minim Invasive Ther Allied Technol, 2015, 24(5):255-263.
[12]	Walther T, Simon P, Dewey T, et al. Transapical minimally invasive aortic valve implantation: multicenter experience [J]. Circulation, 2007, 116(11 Suppl):I240-I245.
[13]	Rettig TC, Rigter S, Nijenhuis VJ, et al. The systemic inflammatory response syndrome predicts short-term outcome after transapical transcatheter aortic valve implantation [J]. J Cardiothorac Vasc Anesth, 2015, 29(2):283-287.
[14]	Kempfert J, Meyer A, Kim WK, et al. First experience without pre-ballooning in transapical aortic valve implantation: a propensity score-matched analysis [J]. Eur J Cardiothorac Surg, 2015, 47(1):31-38.
[15]	Ahad S, Baumbach H, Hill S, et al. Transapical aortic valve implantation and minimally invasive off-pump bypass surgery [J]. Interact Cardiovasc Thorac Surg, 2014, 18(2):248-249.

[1]	张婉微, 秦芸芸, 蔡绮哲, 林明明, 田润雨, 金姗, 吕秀章. 心肌收缩早期延长对非ST段抬高型急性冠脉综合征患者冠状动脉严重狭窄的预测价值[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1016-1022.
[2]	任书堂, 刘晓程, 张亚东, 孙佳英, 陈萍, 周建华, 龙进, 黄云洲. 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[J]. 中华医学超声杂志（电子版）, 2023, 20(10): 1023-1028.
[3]	孙佳英, 黄云洲, 任书堂, 王翠华, 陈新华, 于艾嘉, 陈元禄. 无创心肌做功对左束支传导阻滞患者左心室整体及节段心肌收缩功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 836-843.
[4]	钟露, 曹省, 宋宏宁, 陈金玲, 周青. 超声心动图定量评估二尖瓣反流程度的质量控制[J]. 中华医学超声杂志（电子版）, 2023, 20(07): 705-711.
[5]	应康, 杨璨莹, 刘凤珍, 陈丽丽, 刘燕娜. 左心室心肌应变对无症状重度主动脉瓣狭窄患者的预后评估价值[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 581-587.
[6]	金姗, 丁雪晏, 蔡绮哲, 李一丹, 赵智玲, 郭兮恒, 吕秀章. 左心室压力-应变环对阻塞型睡眠呼吸暂停综合征患者心肌功能的评价[J]. 中华医学超声杂志（电子版）, 2023, 20(06): 575-580.
[7]	张贺彬, 高枫, 郑哲岚, 王晓嫚, 陈丽, 杨寸芯, 胡佩佩. 二维斑点追踪超声心动图对业余马拉松运动员右心室收缩功能的评估[J]. 中华医学超声杂志（电子版）, 2022, 19(10): 1091-1097.
[8]	刘婷婷, 丁明岩, 冀威, 郭丽娟, 李颖, 赵含章, 朱芳. 非冠状动脉梗阻性缺血性心脏病女性患者心率储备与微循环功能障碍的相关性研究[J]. 中华医学超声杂志（电子版）, 2022, 19(10): 1077-1082.
[9]	钟春燕, 董虹美, 张晓航, 冉素真. 胎儿永存左上腔静脉合并肺/主动脉和右/左心室比例异常的产前超声诊断及预后分析[J]. 中华医学超声杂志（电子版）, 2022, 19(09): 933-940.
[10]	杨喆, 尹立雪, 王斯佳, 罗素秋, 赵欣, 周乔, 苏江, 邬锐. 超声血流向量成像对痛风患者左心室能量损耗的初步评价[J]. 中华医学超声杂志（电子版）, 2022, 19(06): 527-534.
[11]	陈樱, 陈艳莉. 高龄孕妇心率变异性原因及围产结局分析[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(03): 295-301.
[12]	江岚, 梁伟翔, 苏春宏, 苏志源, 刘丹丹, 戴丽, 陈敦金. 超声心动图评估妊娠合并严重心脏病患者剖宫产围术期心容量及功能的变化特征[J]. 中华产科急救电子杂志, 2023, 12(01): 28-35.
[13]	李燕伟, 黄大军, 伍洲, 张嬿, 康彧, 孔令秋. 曲折的右心声学造影一例[J]. 中华心脏与心律电子杂志, 2023, 11(03): 179-181.
[14]	翁梓珑, 朱丽, 林大卫, 潘文志, 周达新, 葛均波. 国产经导管瓣膜系统治疗重度主动脉瓣狭窄长期预后及其预测因素分析[J]. 中华心脏与心律电子杂志, 2023, 11(02): 114-119.
[15]	漆祎鸣, 潘文志, 朱风琴, 周达新, 葛均波. 新型冠状病毒感染后经导管主动脉瓣置换术安全性分析[J]. 中华心脏与心律电子杂志, 2023, 11(02): 105-108.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Evaluation of echocardiagraphy in patients with aortic stenosis undergoing transapical aortic valve implantation

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Evaluation of echocardiagraphy in patients with aortic stenosis undergoing transapical aortic valve implantation