组织运动瓣环位移技术在经皮二尖瓣修复术长期随访中的初步研究

Tissue motion mitral annular displacement technique in follow-up of percutaneous mitral valve repair:apreliminary study

目的:探讨组织运动瓣环位移(TMAD)技术在经皮二尖瓣修复术(MitraClip)治疗有症状的中重度二尖瓣反流(MR)患者中的价值,并评价手术的长期效果及其耐久性。方法:回顾性分析2013-10-2014-06应用MitraClip系统治疗有症状的中重度MR患者11例,其中10例患者术后完成超过1个月的随访,纳入后续的数据分析。10例患者分别于术前和术后1个月、1年、2年、3年行经胸超声心动图(TTE)观察MR程度,运用TMAD技术测量二尖瓣环位移指标,将其与各常规心功能指标进行比较并行相关性分析。结果:10例患者均顺利完成手术。3年随访中,3例患者死亡。10例患者术后MR程度及左心房内径均较术前降低,差异具有统计学意义(均P<0.05)。6min步行试验(6MWDT)与生活质量评分(AQoL)术后均较术前提高,差异具有统计学意义(均P<0.05)。TMAD与左心室射血分数(LVEF)存在中等程度相关,与健康生活量表(EQ-5D)存在弱-中等程度相关,与NYHA、6MWDT可能存在边缘相关;而LVEF与NYHA、EQ5D等主观报告数据间不存在相关性。LVEF及左室心腔各指标差异无统计学意义。TMAD各参数术前与术后比较,差异均无统计学意义。结论:TMAD技术为MitraClip术后有效评价心功能提供了一种简便、可行的新方法。MitraClip术能有效改善MR及左房扩大,具有耐久性。

Objective：To investigate the value of tissue motion mitral annular displacement（TMAD）in severe mitral regurgitation patients undergoing percutaneous mitral valve repair（MitraClip）,and to evaluate the efficacy and durability of MitraClip.Method：There were 11 patients with severe mitral regurgitation underwent percutaneous mitral valve repair with MitraClip system from October 2013 to June 2014 and 10 patients among them completed 1-month follow-up and their data was extracted for further analysis.Echocardiography was performed before procedure,before discharge,and at the time of point of one year,two years and three years after procedure.Indicators of TMAD were compared with regular echocardiographic indicators,such as left ventricular ejection fraction（LVEF）.Lastly,correlation analysis was performed between these indicators.Result：MitraClip was successfully implanted in all patients.Three patients died during follow-up.After procedure,both mitral regurgitation severity and left atrium diameter significantly decreased in all patients（all P〈0.05）.6 MWDT and AQoL score elevated when compared with baseline（both P〈0.05）.TMAD was moderately related to LVEF,mildly-to-moderately related to EQ-5 D,and marginally related to NYHA and 6 MWDT.LVEF was not related to NYHA,ED5 Dor other indicators.No changes were observed in LVEF and other indicators of left ventricle.No difference existed between post-procedure follow-up and baseline in all indicators of TMAD.Conclusion：TMAD technique is feasible and convenient in assessing heart function after percutaneous mitral valve repair.MitraClip is durable and efficacious in improving mitral regurgitation and left atrium enlargement.