主动脉瓣狭窄和主动脉瓣反流患者的主动脉解剖学比较

Comparisons of aortic anatomy between aortic stenosis and aortic regurgitation

目的通过多排计算机断层成像(multi-detector computed tomography,MDCT)和超声心动图,比较严重主动脉瓣狭窄(aortic stenosis,AS)和主动脉瓣反流(aortic regurgitation,AR)患者主动脉根部解剖特征,为AR新型器械设计和经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)的治疗提供参考。方法纳入2014年4月至2016年5月连续入组就诊于上海复旦大学附属中山医院,患有严重AS或AR并计划接受TAVR治疗的患者共170例,其中包括AR组57例,AS组113例。所有患者均接受MDCT和超声心动图检查,并对测量数据进行分析。结果AR组患者平均主动脉瓣环直径[(26.4±3.7)mm比(25.2±2.9)mm,P=0.001]、平均升主动脉直径[(38.3±6.9)mm比(33.9±6.7)mm,P<0.001]和主动脉窦直径[(38.9±6.9)mm比(32.7±4.5)mm,P<0.001]均大于AS组患者,差异均有统计学意义。两组患者左冠状动脉开口高度比较,差异无统计学意义(P=0.080);AR组患者右冠状动脉开口高度[(17.5±5.0)mm比(15.3±3.3)mm,P=0.010]高于AS组患者,差异有统计学意义。结论 AS和AR患者主动脉解剖学比较结果可为AR新型器械设计和TAVR治疗提供有价值的信息参考。

Objective To compare aortic root anatomical characteristics between severe aortic valve stenosis(AS)and aortic regurgitation(AR)patients,and to provide useful information for transcatheter aortic valve replacement(TAVR)device designs and procedural techniques for treatment of AR.Methods Consecutive patients admitted between April 2014 to May 2016 with severe AS or AR and planned to undergo transcatheter aortic valve replacement were included.There were a total of 57 AR and 113 AS patients.All patients underwent multi-detector computed tomographic imaging and echocardiography examinations.Results The mean aortic annulus diameter in AR patients was slightly but significantly larger than AS patients[(26.4±3.7)mm vs.(25.2±2.9)mm,P=0.001].The mean diameters of the ascending aorta[(38.3±6.9)mm vs.(33.9±6.7)mm,P<0.001]and Valsalva sinus[(38.9±6.9)mm vs.(32.7±4.5)mm,P<0.001]in AR patients were larger than in AS patients.The left coronary ostia height was of no significant difference between the 2 groups[(12.5±3.7)mm vs.(13.4±3.2)mm,P=0.08]and the right coronary ostia height was higher in the AR group than in the AS group[(17.5±5.0)mm vs.(15.3±3.3)mm,P=0.001].Conclusions The anatomical aortic root data from patients with AS or AR in the present study may provide useful information for transcatheter aortic valve replacement device designs and procedural techniques for treatment of AR.