超声心动图在经导管主动脉瓣置换术前评估与术后随访中的应用价值

Application value of echocardiography in pre-procedure evaluation and post-procedure follow-up in transcatheter aortic valve replacement

目的探讨超声心动图在评估经导管主动脉瓣置换(TAVR)术前与术后心脏结构和功能改变中的应用价值。方法回顾性选取2014年9月至2019年7月在复旦大学附属中山医院心内科行TAVR的重度主动脉瓣狭窄(SAS)患者47例。所有患者均于术前及术后6个月行经胸超声心动图检查并记录常规超声心动图参数和主动脉瓣相关参数,包括左心室收缩末期内径(LVESD)、左心室舒张末期内径(LVEDD)、室间隔厚度(IVST)、后壁厚度(PWT)、肺动脉收缩压(PASP)、主动脉瓣最大跨瓣压差(AVPGmax)、主动脉瓣平均跨瓣压差(AVPGmean)、主动脉瓣有效瓣口面积(AVA)、左心室射血分数(LVEF)、主动脉根部内径(AORD)、左心房内径(LAD),分析TAVR术前与术后的超声心动图参数变化。结果与术前相比,术后47例患者的LVESD、IVST、PWT、PASP、AVPGmax、AVPGmean均明显减小,差异均有统计学意义(P均<0.05);AVA和LVEF均明显变大,差异均有统计学意义(P均<0.05)。术后合并二尖瓣反流中度及以上或三尖瓣反流中度及以上的患者较术前明显减少(8例vs 3例,7例vs 2例)。结论TAVR可纠正主动脉瓣狭窄,改善患者心功能。超声心动图相关参数有助于TAVR术后人工瓣膜及患者心脏结构功能的随访评估。

Objective To assess the value of echocardiography in evaluating the cardiac structure and function before and after transcatheter aortic valve replacement(TAVR).Methods A total of 47 patients with severe aortic valve stenosis(SAS)who underwent TAVR at the Department of Cardiology,Zhongshan Hospital of Fudan University from September 2014 to July 2019 were retrospectively enrolled.All patients received echocardiography before and 6 months after TAVR,and conventional echocardiography parameters and aortic valve-related parameters were routine recorded.Echocardiographic parameters,including left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),interventricular septum thickness(IVST),left ventricular posterior wall thickness(PWT),pulmonary artery systolic pressure(PASP),maximum aortic valve pressure gradient(AVPGmax),mean aortic valve pressure gradient(AVPGmean),aortic valve effective orifice area(AVA),left ventricular ejection fraction(LVEF),aortic root diameter(AORD),and left atrial diameter(LAD)were collected,and left ventricular mass index was calculated according to LVEDD,IVST,and PWT.The changes of TAVR echocardiographic parameters pre-and post-procedure were analyzed.Results Compared with the values on admission,LVESD,IVST,PWT,PASP,AVPGmax,and AVPGmean at follow-up were significantly decreased in the patients(P<0.05).Both AVA and LVEF significantly increased(P<0.05).The number of cases with moderate or above mitral regurgitation and tricuspid regurgitation decreased significantly post-procedure(8 vs 3,7 vs 2).Conclusion TAVR can correct aortic stenosis(AS)and improve cardiac function.Echocardiography plays a crucial role in evaluating the cardiac construction and function and the prosthesis after TAVR.