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中华医学超声杂志(电子版) ›› 2021, Vol. 18 ›› Issue (10) : 948 -953. doi: 10.3877/cma.j.issn.1672-6448.2021.10.009

心血管超声影像学

超声心动图在经导管主动脉瓣置换术前评估与术后随访中的应用价值
胡春强1, 李伟1, 赵维鹏1, 葛振一1, 周达新2, 潘文志2, 舒先红1, 潘翠珍1,()   
  1. 1. 200032 上海市心血管病研究所 上海市影像医学研究所 复旦大学附属中山医院心脏超声诊断科
    2. 200032 上海市心血管病研究所 上海市影像医学研究所 复旦大学附属中山医院心内科
  • 收稿日期:2021-05-29 出版日期:2021-10-01
  • 通信作者: 潘文志, 潘翠珍

Application value of echocardiography in pre-procedure evaluation and post-procedure follow-up in transcatheter aortic valve replacement

Chunqiang Hu1, Wei Li1, Weipeng Zhao1, Zhenyi Ge1, Daxin Zhou2, Wenzhi Pan2,, Xianhong Shu1, Cuizhen Pan1()   

  1. 1. Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Shanghai 200032, China
    2. Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai Institute of Medical Imaging, Shanghai 200032, China
  • Received:2021-05-29 Published:2021-10-01
  • Corresponding author: Wenzhi Pan, Cuizhen Pan
引用本文:

胡春强, 李伟, 赵维鹏, 葛振一, 周达新, 潘文志, 舒先红, 潘翠珍. 超声心动图在经导管主动脉瓣置换术前评估与术后随访中的应用价值[J/OL]. 中华医学超声杂志(电子版), 2021, 18(10): 948-953.

Chunqiang Hu, Wei Li, Weipeng Zhao, Zhenyi Ge, Daxin Zhou, Wenzhi Pan, Xianhong Shu, Cuizhen Pan. Application value of echocardiography in pre-procedure evaluation and post-procedure follow-up in transcatheter aortic valve replacement[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(10): 948-953.

目的

探讨超声心动图在评估经导管主动脉瓣置换(TAVR)术前与术后心脏结构和功能改变中的应用价值。

方法

回顾性选取2014年9月至2019年7月在复旦大学附属中山医院心内科行TAVR的重度主动脉瓣狭窄(SAS)患者47例。所有患者均于术前及术后6个月行经胸超声心动图检查并记录常规超声心动图参数和主动脉瓣相关参数,包括左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVST)、后壁厚度(PWT)、肺动脉收缩压(PASP)、主动脉瓣最大跨瓣压差(AVPGmax)、主动脉瓣平均跨瓣压差(AVPGmean)、主动脉瓣有效瓣口面积(AVA)、左心室射血分数(LVEF)、主动脉根部内径(AORD)、左心房内径(LAD),分析TAVR术前与术后的超声心动图参数变化。

结果

与术前相比,术后47例患者的LVESD、IVST、PWT、PASP、AVPGmax、AVPGmean均明显减小,差异均有统计学意义(P均<0.05);AVA和LVEF均明显变大,差异均有统计学意义(P均<0.05)。术后合并二尖瓣反流中度及以上或三尖瓣反流中度及以上的患者较术前明显减少(8例vs 3例,7例vs 2例)。

结论

TAVR可纠正主动脉瓣狭窄,改善患者心功能。超声心动图相关参数有助于TAVR术后人工瓣膜及患者心脏结构功能的随访评估。

Objective

To assess the value of echocardiography in evaluating the cardiac structure and function before and after transcatheter aortic valve replacement (TAVR).

Methods

A total of 47 patients with severe aortic valve stenosis (SAS) who underwent TAVR at the Department of Cardiology, Zhongshan Hospital of Fudan University from September 2014 to July 2019 were retrospectively enrolled. All patients received echocardiography before and 6 months after TAVR, and conventional echocardiography parameters and aortic valve-related parameters were routine recorded. Echocardiographic parameters, including left ventricular end-systolic diameter (LVESD), left ventricular end-diastolic diameter (LVEDD), interventricular septum thickness (IVST), left ventricular posterior wall thickness (PWT), pulmonary artery systolic pressure (PASP), maximum aortic valve pressure gradient (AVPGmax), mean aortic valve pressure gradient (AVPGmean), aortic valve effective orifice area (AVA), left ventricular ejection fraction (LVEF), aortic root diameter (AORD), and left atrial diameter (LAD) were collected, and left ventricular mass index was calculated according to LVEDD, IVST, and PWT. The changes of TAVR echocardiographic parameters pre- and post-procedure were analyzed.

Results

Compared with the values on admission, LVESD, IVST, PWT, PASP, AVPGmax, and AVPGmean at follow-up were significantly decreased in the patients (P<0.05). Both AVA and LVEF significantly increased (P<0.05). The number of cases with moderate or above mitral regurgitation and tricuspid regurgitation decreased significantly post-procedure (8 vs 3, 7 vs 2).

Conclusion

TAVR can correct aortic stenosis (AS) and improve cardiac function. Echocardiography plays a crucial role in evaluating the cardiac construction and function and the prosthesis after TAVR.

图1 重度主动脉瓣狭窄患者经导管主动脉瓣置换(TAVR)术前与术后6个月随访超声心动图图像。图a~d为术前超声图像,其中图a为胸骨旁左心室长轴切面测量主动脉根部解剖结构,可显示左心室流出道、主动脉瓣环、主动脉窦部、窦管交界处、升主动脉(图中AA为主动脉瓣环,AoS为主动脉窦部,STJ为窦管交界处,AAO为升主动脉);图b,c为心尖五腔心切面勾勒左心室流出道、主动脉瓣口频谱多普勒,获得速度时间积分及主动脉瓣相关参数;图d为心尖五腔心切面彩色多普勒显示重度二尖瓣反流。图e~h为术后6个月超声图像,其中图e为胸骨旁左心室长轴切面显示人工生物主动脉瓣位置固定;图f根据连续方程法估算人工主动脉瓣有效瓣口面积为2.15 cm2;图g示主动脉瓣平均跨瓣压差(AVPGmean)从术前的88 mmHg(1 mmHg=0.133 kPa)降至术后的8 mmHg;图h为彩色多普勒显示重度二尖瓣反流术后转为轻度二尖瓣反流
图2 QLAB-3DQ软件定量主动脉瓣环的最大径、最小径、面积
表1 3D-TEE与MSCT术前评估主动脉根部结构比较(
xˉ
±s
表2 TAVR术前与术后6个月超声心动图常规参数比较
表3 TAVR术前与术后6个月主动脉瓣相关超声心动图参数比较(
xˉ
±s
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