二尖瓣置换术后瓣周漏的介入治疗效果分析

Efficacy of interventional therapy on paravalvular leakage after mitral valve replacement

目的 探讨二尖瓣置换术后瓣周漏的介入治疗效果.方法 回顾性分析2014年4月至2015年5月在西京医院行介入治疗的15例二尖瓣置换术后瓣周漏患者的临床资料.其中,男性8例,女性7例;年龄（53.5±11.7）岁.术前心功能（NYHA分级）Ⅲ级9例,Ⅳ级6例;术前左心室射血分数为（46.8±8.2）％,二尖瓣反流量为12.0 （10.0,15.0）ml.首选局部麻醉下,经股动脉途径在二尖瓣瓣周漏处置入封堵器;对于复杂患者,可选择全身麻醉下经心尖小切口结合房间隔穿刺,进行封堵器的置入.术后评价介入治疗的效果及并发症,并进行出院后随访.结果 介入治疗距离初次手术时间为5.0 （0.6,7.0）年.1例患者因手术耐受性较差而未能完成介入治疗,手术成功率为93.3％（14/15）.手术时间（126.7±56.4）min,X线曝光时间（21.0±10.0）min,住院时间7.0 （6.0,10.0）d.术后并发症包括咯血1例,血尿1例,急性肾功能衰竭1例,输血4例.术后随访时间为7.0（4.0,12.0）个月,患者无死亡,未出现严重并发症;术后1个月,左心室射血分数增加至（52.1±4.3）％,二尖瓣反流量减少至0.5（0,2.0）ml,与术前比较差异均有统计学意义（P均＜0.05）.结论 二尖瓣置换术后瓣周漏的介入治疗安全、有效,长期效果需要迸一步研究.

Objective To evaluate the efficacy of transcatheter intervention of paravalvular leakage （PVL） after mitral valve replacement.Methods Present respective study included 15 patients （8 males and mean age （53.5 ＆#177; 11.7） years） with mitral PVL who underwent interventional therapy in our hospital from April 2014 to May 2015.There were 9 cases with NYHA heart function Ⅲ,6 cases with NYHA heart function Ⅳ.Left ventricular ejection fraction was （46.8 ＆#177; 8.2） %,and mitral regurgitation volume was 12.0 （10.0,15.0）ml before the intervention.Transcatheter intervention was carried out in the catheterization laboratory or the hybrid operation room with initial local anesthesia.By puncturing femoral artery and implantation of different congenital heart disease devices,the mitral PVL were occluded interventionally.To some complicated cases,the occluder was implanted by puncturing apex and atrial septum.Follow-up evaluation included peri-operational mortality,complications and postoperative residual shunt.Results The median time between transcatheter intervention and previous operation was 5.0 （0.6,7.0） years.One patient did not tolerate the operation and occlude was not implanted in this patient.The success rate of transcatheter intervention was 93.3% （14/15）.The average operation time was （126.7：＆#177;56.4）min,and X ray exposure time was （21.0 ＆#177; 10.0）min,and median hospitalization time was 7.0 （6.0,10.0）d.The main post-operative complications included 1 case of hemoptysis,1 case of acute renal failure,1 case of hematuria and 4 cases of blood transfusion.The median follow-up time was 7.0 （4.0,12.0） months.During the follow-up,there was no death and no serious complications.One month after the procedure,left ventricular ejection fraction significantly increased to （52.1 ＆#177; 4.3）%,and median mitral regurgitation significantly reduced to 0.5 （0,2.0） ml （all P 〈 0.05）.Conclusion The interventional therapy for PVL after mitral valve replacement is safe and effective,and further studies are warranted to observe the long-term effect of this procedure.