重度主动脉瓣狭窄患者二叶式主动脉瓣的超声心动图分析

Prevalence and echocardiographic feature of bicuspid aortic valve in patients with severe aortic stenosis： a echocardiography database analysis

目的 探讨超声心动图辨认主动脉瓣叶数的准确性,并利用超声心动图分析重度主动脉瓣狭窄（AS）患者二叶式主动脉瓣（BAV）的比例,为经导管主动脉瓣置换术（TAVR）的应用提供信息.方法 入选2009年1月至2013年7月在复旦大学附属中山医院行单纯主动脉瓣置换术的患者300例,以外科术中的探查结果作为标准,计算超声心动图辨认主动脉瓣叶数的准确度.另外,从2004至2012年复旦大学附属中山医院超声心动图数据库中连续选取重度AS（可合并主动脉瓣反流,但AS为主要的病变）患者1 371例,回顾性分析BAV的比例和检查结果.结果 应用经胸超声心动图可以辨认75.7％（227/300）重度AS患者的主动脉瓣叶,辨认主动脉瓣叶数的准确度为89.4％ （203/227）.在1 371例重度AS患者中,＜40、40～59、60 ～ 69、70～ 79和≥80岁患者的BAV比例分别为60.0％（57/95）、57.5％（262/456）、42.7％（184/431）、43.2％（133/308）和21.0％（17/81）.退行性钙化病变患者的BAV比例比风湿性心脏病患者高[44.3％ （552/1 246）比4.0％（3/76）,P＜0.01],而无钙化性病变的先天性畸形患者的BAV比例最高（95.8％）.与三叶式瓣患者相比,BAV患者主动脉瓣反流≥2级的比例较低,左心室舒张末期内径较小,升主动脉内径较大（P均＜0.01）,主动脉瓣环内径和合并心血管疾病的比例差异均无统计学意义（P均＞0.05）.结论 经胸超声心动图辨认主动脉瓣叶数的准确度较高,重度AS患者BAV常见,但BAV的比例并不高于西方人群.

Objective To evaluate the accuracy of echocardiography in identifying aortic valve structures and determine the prevalence of bicuspid aortic valves （BAV） in severe aortic stenosis （AS） population to provide useful information for transcatheteraortic valve replacement （TAVR）.Methods A total of 300 AS patients undergoing surgical aortic valve replacement were included to determine the accuracy of transthoracic echocardiography in indentifying BAV from January 2009 to July 2013.The echocardiographic data of our hospital from 2004 to 2012 was retrospectively reviewed.1 371 patients with isolated severe native aortic valves stenosis were consecutively enrolled.Results The aortic valve structures could be defined by transthoracic echocardiography in 75.7％ （227/300） patients with severe AS.With BAV diagnosis during operation as gold standard,the accuracy of transthoracic echocardiography in identifying BAV was 89.4％ （203/227）.Among 1 371 patients with severe AS,the percentage of BAV in patients aged ＜ 40 years,aged 40-59 years,aged 60-69 years,aged 70-79 years and aged ≥ 80 years was 60.0％ （57/95）,57.5％ （262/456）,42.7％ （184/431）,43.2％ （133/308） and 21.0％ （17/81）,respectively.Incidence of BAV in patients with degenerative calcific valve was significant higher than in those with rheumatic heart disease （44.3％ （552/1 246） vs.4.0％ （3/76）,P ＜ 0.01）.Proportion of combined aortic regurgitation≥ grade 2 was significantly lower,ascending aortic diameter was larger and left ventricular end-diastolic dimension was smaller in BAV patients compared to severe AS patients with tricuspid valves （all P ＜ 0.01）,while aortic valve annuals diameter and accompanying cardiovascular diseases between BAV and tricuspid aortic valve groups were similar （all P ＞ 0.05）.Conclusions Transthoracic echocardiography could accurately identify aortic valve structures in about 76％ patients.BAV is common in severe AS patients across all ages.These results provide important information for the popularization of TVAR.