超声心动图在经导管主动脉瓣置入术中的作用

Echocardiography in transcatheter aortic valve implantation

目的探讨超声心动图在经导管主动脉瓣置入术前、术中及术后的作用。方法 59例三叶式主动脉瓣重度狭窄或反流患者行经导管主动脉瓣置入术,术前经胸超声心动图评估主动脉瓣狭窄或反流程度、测量主动脉根部内径,评估心功能,术中介入操作前经食管超声心动图再次测量主动脉根部内径;介入过程中引导瓣膜植入、监测并发症,术后即刻评估置入瓣膜效果和经胸超声心动图随访人工瓣膜功能、左室收缩功能、左室质量指数等。结果 59例三叶式主动脉瓣患者中重度主动脉狭窄49例,单纯中-重度主动脉瓣反流10例。术前经胸超声心动图(TTE)所测的主动脉瓣环径与经食管超声心动图(TEE)测值比较(22.4±2.3mm vs.24.8±2.1mm)差异有统计学意义(P<0.05),其余主动脉根部内径(主动脉窦部内径、主动脉窦管交界处内径、主动脉窦部高度,左室流出道内径,升主动脉内径)测值间比较差异均无统计学意义。术中1例患者右冠状动脉开口堵塞,经导管主动脉瓣植入术(TAVI)置入失败转入心外科开胸手术,其余患者均成功置入瓣膜。术后即刻评估瓣周漏微量或无占67%,轻度占31%,中度仅占2%。术后1周及术后3月主动脉瓣口前向血流速度、最大压差、平均压差较术前均明显降低。术后1周左室质量指数较术前明显降低,术后3月进一步降低。术后1周左室射血分数(EF)有所恢复,术后3月恢复正常。结论超声心动图检查在TAVI治疗中不可或缺,在术前评估、术中监测及术后随访中均起着非常重要的临床作用。

Objective To investigate the pre-procedural,peri-procedural and post-procedural role of echocardiography in transcatheter aortic valve implantation（TAVI）.Methods 59 patients underwent TAVI in our hospital with tricuspid aortic valve stenosis or regurgitation.Before TAVI,the severity of aortic stenosis or regurgitation,aortic root diameters and left ventricular function were evaluated by transthoracic echocardiography（TTE）.During TAVI,the aortic root diameters were measured again by transesophageal echocardiography（TTE）pre-procedure,and the use of peri-procedural TEE was to guide prosthesis implantation,monitor complications,and evaluate the function of the prosthetic valve.After TAVI,the follow-up by TTE included the function of prosthetic valve,left ventricular function and left ventricular mass index（LVMI）.Results Of 59 cases of tricuspid aortic valve,49 cases were severe aortic stenosis,and 10 cases were moderate to severe aortic regurgitation.The aortic annular diameter was significantly different between TTE and TEE measurements（22.4±2.3mm vs.24.8±2.1mm）,but other aortic root diameters had no statistical significance.One of the patients was transferred to surgical replacement as a result of the occlusion of the right coronary artery,but others were successfully underwent TAVI.Post-procedure,67% patients had none or trace paravalvular regurgitation（PVL）,31% had mid PVL,and only 2% had moderate PVL.Compared with the values before TAVI,the aortic velocity,maximum gradient,and mean gradient decreased significantly one week and 3months after TAVI.The LVMI decreased one week and more 3months after TAVI.The left ventricular ejection fraction increased one week later,and recovered to normal 3months later.Conclusion Echocardiography plays an important role in pre-procedural evaluation,peri-procedural monitoring and post-procedural follow-up in TAVI.