经皮主动脉瓣置换术中的二尖瓣反流

Mitral regurgitation in aortic stenosis patients during transcatheter aortic valve replacement

主动脉瓣狭窄(aortic stenosis,AS)已成为最为常见的心脏瓣膜病变之一.经皮主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)为无法进行外科手术或外科手术高危的重度/中-重度AS患者提供了一种创伤更小的治疗方法,是近年来国内外发展的热点.由于TAVR手术自身特点,二尖瓣反流(mitral regurgitation,MR)的评价和改变对其尤为重要.目前针对TAVR手术的MR的研究主要集中于术后MR的变化及其影响,但TAVR术中可能出现明显的MR程度的变化,其变化趋势、影响因素及其对患者预后的影响应受到更多重视.超声心动图是评价和监测MR的重要手段,可以较为准确地反映MR变化趋势,对其对预后的影响进行判断,探讨术中MR变化的可能机制.随着超声心动图技术的发展,需要引进更为灵敏客观的指标预测及监测TAVR术中MR的变化趋势,进一步寻找术中MR可能的影响因素.

Aortic stenosis(AS)is one of the most common valvular heart diseases.Transcatheter aortic valve replacement(TAVR)has made it is possible to receive potentially life-saving treatmen for the patients who are older or sicker.Due to the limit of management of mitral valve diseases,the change of mitral regurgitation(MR)and its assessment become more important to the evaluation during TAVR.However,concomitant MR and its variation during TAVR has not been evaluated formally.Several elements may have influence on mitral valve equipment,which will further aggravate MR during the operation.including impingement of prosthetic structure on the anterior mitral leaflet,organic damage of the mitral valve apparatus,dynamic obstruction of left ventricular outflow tract,left ventricle size,wire oversizing,calcific mitral apparatus and functional mitral regurgitation.Organic laceration has to be solved through operation,while dynamic and functional regurgitation may be alleviated by medication.That means that it is vital to detect the causes of the MR.Echocardiography is an importan tool to estimate MR and to tell the possible reasons of the MR aggravation.However,the reasons may be complicated and difficult to analyze.More sensitive indicators may be needed for more accurate risk assessment during TAVR.