实时三维超声心动图在经导管主动脉瓣置换术中的应用价值

Value of Real Time 3-dimensional Echocardiography in Patients Undergoing Transcatheter Aortic Valve Replacement

目的:回顾性探究实时三维超声心动图在经导管主动脉瓣置换术(TAVR)的术前评估筛选、术中监测指导以及术后功能恢复评价中的意义和价值。方法:选取经超声心动图诊断的主动脉瓣中-重度狭窄并行TAVR的患者共54例,分析所有患者的术前疾病状态包括主动脉瓣形态、瓣口面积等参数,统计此类患者在术中所出现的瓣周漏的比例以及类型,比较术前、术后患者左心室功能数据改变,明确实时三维超声心动图在这类患者不同阶段所发挥的作用。结果:54例患者中以三叶式主动脉瓣居多,其中利用二维超声心动图联合实时三维超声心动图检出二瓣化畸形患者8例,1例疑似二瓣化畸形并最终由CT确诊;术中共发生36例少-中量瓣周漏,最终均由三维超声心动图明确瓣周漏位置及大小;利用三维超声心动图检测术前及术后患者左心室部分功能参数,与术前相比,患者术后主动脉瓣有效瓣口面积扩大、左心室射血分数提高、左心室收缩末期容积减小,差异均有统计学意义(P<0.05)。结论:实时三维超声心动图在TAVR中能够协助临床医师进行术前疾病判断、术中实时监测和指导并精准评价手术的效果,为此类手术的临床推广带来帮助。

Objectives:To retrospectively explore the value of real-time 3-dimensional echocardiography in preoperative evaluation,intraoperative monitoring and guidance and postoperative evaluation of patients undergoing transcatheter aortic valve replacement(TAVR).Methods:A total of 54 patients with moderate to severe aortic stenosis diagnosed by echocardiography and treated with transcatheter aortic valve replacement were included in this analysis.The preoperative disease status of all patients was evaluated.Aortic valve anatomical form,valve orifice area and other parameters,and the proportion and type of perivalvular leakage occurred during the operation were analyzed,and the changes in left ventricular functional data of patients before and after the TAVR were compared,the role of real-time 3-dimensional echocardiography in different operative stages of these patients were verified.Results:Tricuspid aortic valve was evidenced in the majority of these patients.Eight patients with bicuspid aortic valve were detected by 2-dimensional echocardiography combined with real-time 3-dimensional echocardiography,and 1 bicuspid aortic valve patient was suspected by echocardiography examination and finally confirmed by CT examination.Intraoperative less than moderate perivalvular leakage occurred in 36 cases,and the position and size of perivalvular leakage were determined by 3-dimensional echocardiography.3-dimensional echocardiography was helpful on more accurate evaluation of left ventricular function of the patients before and after TRVR.Compared with the patients before surgery,valve orifice area and the left ventricular ejection fraction of the patients increased and the left ventricle end-systolic volume decreased after TAVR(all P<0.05).Conclusions:Real-time 3-dimensional echocardiography is helpful on preoperative evaluation,intraoperative monitoring and guidance as well as postoperative evaluation of patients undergoing transcatheter aortic valve replacement,which might facilitate the clinical promotion of TAVR.