超聲心動圖在經導管二尖瓣夾合術治療二尖瓣反流的應用

The Value of Echocardiogram Guidance for MitraClip Procedure in Mitral Regurgitation Patients

目的探討超聲心動圖(經胸及經食管)對經導管二尖瓣夾合術治療重度二尖瓣反流的操作指導和療效評估的價值。方法2015年12月~2016年12月於本院使用Mitra Clip系統在TEE引導下行經導管二尖瓣夾合術的有症狀重度二尖瓣反流患者7例,總結經食管超聲心動圖指導術中操作的經驗,分析7例患者術前及術後1週臨床表現、經胸超聲心動圖變化以及術後1月併發症隨訪。結果7例患者均順利完成手術,5例患者置入1個MitraClip,2例患者置入2個MitraClip,術後即刻二尖瓣反流量均較術前下降1~3級。術後1週複查超聲心動圖示急性手術成功率為71.4%(定義為出院前二尖瓣反流≤2級);術後1週二尖瓣反流束長度由術前(3.88±0.354)級降至術後(2.13±1.36)級(P=0.006),二尖瓣反流面積由(13.74±8.57)c m^(2)下降至(6.55±4.46)c m2(P=0.043),患者N Y H A心功能分級由術前平均(3.71±0.49)級降至術後(2.29±0.76)級(P=0.003),其差異均具有統計學意義。術後1週主動脈平均壓、肺動脈收縮壓、左心室舒張末期內徑、左心房內徑與術前比較無統計學差異。術後1月隨訪,除1例患者因金屬夾移位引起腱索斷裂、二尖瓣反流加重、心力衰竭導致死亡之外,其餘患者無併發症發生。結論超聲心動圖可指導經導管二尖瓣夾合術治療重度二尖瓣反流的術中操作,評估術後療效;同時,經導管二尖瓣夾合術對經過選擇的重度二尖瓣反流患者安全、有效,中長期效果需待進一步隨訪。

Objective To investigate the value of echocardiogram(transesophageal and transthoracic echocardiogram)guidance for MitraClip procedure in severe mitral regurgitation patients.Methods Between December 2015 and December 2016,seven MitraClip procedures were performed in our hospital for symptomatic severe mitral regurgitation by the guidance of transesophageal echocardiogram.The efficacy and complications of the procedure were analyzed.Results MitraClip procedure was successful in all seven cases.TEE demonstrated MR was reduced by 1 to 3 grades for all patients.Short term success rate was 71.4%at first week post-operation.One week after the procedure,MR was reduced from(3.88±0.354)grade to(2.13±1.36)grade(P=0.006),and MR area was reduced from(13.74±8.57)cm2 to(6.55±4.46)cm2(P=0.043).NYHA classification improved from(3.71±0.49)grade to(2.29±0.76)grade(P=0.003).There was no statistically significant difference in mean arterial pressure,pulmonary artery systolic pressure,left ventricularend-systolic dimension or left atrial dimension.No complications occurred in all patients except one patient suffered from rupture of chordate tendinea due to one clip detachment,finally leading to exacerbation of heart failure and death.Conclusion Echocardiogram plays a key role in guiding the MitraClip procedure in mitral regurgitation patients,and in assessing procedure efficacy.However,the long-term benefit of the procedure needs to be validated through longer follow up.