经食管超声心动图引导FustarTM可调弯鞘封堵主动脉瓣瓣周漏手术经验总结

Experience of Transesophageal Echocardiography Guided Aortic Paravalvular Leak Closure With Intervention Pathway Established by FustarTM Steerable Introducer

目的:总结在经食管超声心动图(TEE)引导下,采用FustarTM可调弯鞘建立路径,非X线照射下封堵主动脉瓣瓣周漏的经验和体会。方法:于2017年1月至12月,入选心脏瓣膜置换手术后并发瓣周漏、反复心力衰竭患者2例,均经超声心动图确认无误。其中,主动脉瓣、主动脉瓣和二尖瓣机械瓣置换术后各1例。取胸骨右缘第2肋间4cm切口入路,经升主动脉部,穿刺置入FustarTM可调弯鞘入主动脉内,在TEE引导下,调整弯鞘头端经瓣周漏入左心室,经弯鞘置入封堵器完成瓣周漏封堵。结果:2例均封堵成功,无残余反流,无卡瓣或瓣膜损伤,无严重心律失常、无封堵器脱落等并发症。手术时间55~70min,心内操作15~25min,术中出血量小于100ml,NYHA心功能分级均为Ⅰ级,左心室内径较前明显缩小。结论:在TEE引导下,采用FustarTM可调弯鞘协助建立路径,封堵器封堵瓣周漏安全、有效。FustarTM可调弯鞘在TEE下显影清晰,经胸骨旁途经操作更加可控,减少手术操作时间,减少并发症,避免X线照射。

Objectives:Paravalvular leak(PVL) is an unwanted complication after heart valve replacement surgery.This report summarized the experience of using transesophageal echocardiography(TEE) guided FustarTM Steerable Introducer to establish pathway for the closure of paravalvular leak without X-ray exposure.Methods:Clinical data of 2 cases of PVL patients with severe heart failure,who hospitalized in our hospital from January 2017 to December 2017,were included.One case was PVL post aortic mechanical valve replacement,the other was PVL post mechanical aortic valve and mitral valve replacement.The approach started from 4 cm incision of the second intercostal of the right edge of the sternum and the ascending aorta was exposed.The FustarTM Steerable Introducer was inserted into the aorta.Under the guidance of the TEE,the head of FustarTM Steerable Introducer was adjusted and inserted into left ventricle through the PVL.Transcatheter closure of circumferential leakage was achieved with curved sheath occluder.Results:All cases were successfully occluded without residual reflux.There was no disc and valve injuries,no serious arrhythmia,no occluder loss and other complications.The operation time was 55~70 min,the intra-cardiac operation time was 15~25 min,the bleeding during the operation was less than 100 ml,the NYHA heart function was grade I before discharge,and the left ventricular internal diameter before discharge was significantly smaller than preoperative value.Conclusions:Under the guidance of TEE,the FustarTM Steerable Introducer adjustable curved sheath is used to assist in the establishment of the intervention pathway.This procedure is valuable for the safe and effective to closure of PVL with the occluder.TEEderived imaging of FustarTM steerable introducer adjustable curved sheath is clear,and operation via parasternal is more controllable,and related to shorter operation time and reduce procedure-related complications,and without the need to receive x-ray exposure.