经食管超声心动图在经导管主动脉瓣Corevalve植入术中的初步应用

Preliminary evaluation of transesophageal echocardiography in patients with serious calcific aortic stenosis undergoing transcatheter aortic Corevalve implantation

目的初步探讨经食管超声心动图在钙化性重度主动脉瓣狭窄患者经导管主动脉瓣Corevalve植入术中的监测价值。方法11例外科手术高危的老年钙化性重度主动脉瓣狭窄患者行经导管主动脉瓣Corevalve植入术。人工主动脉瓣Corevalve植入前应用经食管超声心动图观察主动脉瓣病变程度，准确测量主动脉根部及升主动脉各内径；植入中经食管超声监测球囊位置并指导瓣膜释放；植入后监测人工瓣膜位置及功能，且手术全程监测有无并发症的发生。结果9例患者经导管主动脉瓣植入术均获得成功；另2例患者植入第1枚Corevalve瓣后出现大量瓣周反流，再分别植入1枚瓣中瓣后瓣周反流减为少量而达到理想结果。所有人工瓣膜位置稳定，主动脉瓣口峰值跨瓣压差[（89．82±25．84）mmHg对（19．18±5．65）mmHg，P〈0．01]、平均跨瓣压差[（55．00±20．05）mmHg对（9．91±3．02）mmHg，P〈0．01]明显降低，主动脉瓣口有效面积由（0．57±0．16）cm2明显增加至（1．55±0．31）cm2（P〈0．01）；11例患者均未出现脑血管意外、冠脉堵塞等并发症。结论经导管主动脉瓣植入术是外科手术高危钙化性重度主动脉瓣狭窄患者的有效治疗方法，经食管超声心动图在人工瓣膜植入过程中起着重要协作作用。

Objective To explore the evaluation of transesophageal echocardiography （TEE） in patients with serious calcifie aortic stenosis undergoing transcatheter aortic Corevalve implantation（TAVI）. Methods Eleven patients with serious calcific aortic stenosis underwent TAVI. Philips iE33 color Doppler ultrasound diagnostic instrument was used,equipped with transesophageal probe X7-2t. Aortic valve lesions area and degree, aortic root dimension, inner diameter of ascending aorta were evaluated before Corevalve implantation by TEE. The position of balloon was monitoring during implantation,Corevalves function and positon after implantation were observed. Results TAVI for nine subjects were succeeded. Other two subjects reached the ideal result after 2 Corevalve implantation. The Corevalve postion was stable. Aortic peak gradient [（89.82 ± 25.84）mmHg vs （19.18± 5.65） mmHg, P 〈0. 011 and mean pressure gradient [（55.00 ± 20.05）mmHg vs （9.91 ± 3.02）mmHg, P 〈0.01] declined obviously, effective aortic valve area increased markedly [（0.57 ± 0.16） cm2 vs （1.55 ± 0.31） cm2 , P 〈 0.01]. Conclusions TAVI was an effective treatment for patient with serious calcific aortic stenosis, TEE played an important role during TAVI.