单纯经食管超声心动图引导经导管缘对缘修复治疗三尖瓣关闭不全的初步经验

Initial experience of transcatheter edge-to-edge repair guided by only transesophageal echocardiography in the treatment of tricuspid insufficiency

目的评估单纯经食管超声心动图引导经导管三尖瓣缘对缘修复手术的可行性和安全性。方法前瞻性研究。2022年1月至2023年5月,在云南省阜外心血管病医院就诊的重度三尖瓣关闭不全患者,经临床评估和超声心动图评估符合纳入标准,行经导管三尖瓣缘对缘修复手术。手术在全身麻醉气管插管和单纯经食管超声引导下进行。手术后1个月接受临床评估和心电图、经胸超声心动图等检查。结果共纳入22例患者,男12例,女10例,年龄(71.3±6.7)岁。22例患者均成功完成三尖瓣经导管缘对缘修复手术,植入夹子(1.5±0.6)枚,术后即刻6例为无或微量反流,15例为轻度反流,1例为中度反流。22例患者均完成术后30 d随访,三尖瓣反流4例为微量,17例为轻度,1例为中度。三尖瓣反流超声心动图测量指标包括有效反流面积、反流容积、缩流颈宽度、近端等速表面积半径均较术前减小(均P<0.05)。此外,下腔静脉宽度、右心房容积、三尖瓣环直径、右心室舒张末直径均较术前改善(均P<0.05),但三尖瓣环收缩期位移、右心室面积变化分数与术前比较差异均无统计学意义(均P>0.05)。结论单纯经食管超声心动图引导经导管三尖瓣缘对缘修复手术初步证实具有可行性和安全性。

Objective To evaluate the feasibility and safety of transcatheter tricuspid valve edge-to-edge repair guided by only transesophageal echocardiography(TEE).Methods Patients with severe tricuspid regurgitation in Fuwai Yunnan Cardiovascular Hospital who met the inclusion criteria based on clinical and echocardiographic evaluationand underwent transcatheter tricuspid valve edge-to-edge repair between January 2022 and May 2023 were prospectively enrolled.The procedure was performed under general anesthesia with endotracheal intubation and solely guided by TEE.The patients underwent clinical evaluation,electrocardiogram and transthoracic echocardiography one month after the procedure.Results A total of 22 patients(12 males and 10 females)were included,with an average age of(71.3±6.7)years.All 22 patients successfully underwent the transcatheter tricuspid valve edge-to-edge repair under TEE guidance,with an average of(1.5±0.6)clips implanted.Immediately after procedure,six patients had no or trace regurgitation,15 patients had mild regurgitation,and one patient had moderate regurgitation.All 22 patients completed 30-day follow-up,with four patients having trace regurgitation,17 patients having mild regurgitation,and one patient having moderate regurgitation.Echocardiographic measurements revealed that effective regurgitant orifice area,regurgitant volume,vena contracta width,and proximal isovelocity surface area radius significantly decreased after the procedure(all P<0.05).In addition,inferior vena cava width,right atrial volume,tricuspid annular diameter,and right ventricular end-diastolic diameter significantly improved(all P<0.05),but tricuspid annular plane systolic excursion and right ventricular fractional area change did not show significant differences compared with those before the procedure(both P>0.05).Conclusion It has been preliminarily confirmed that transcatheter tricuspid valve edge-to-edge repair solely guided by TEE is feasible and safe,but requires more large-scale studies for further validation.