经食管超声心动图在Memoclip经心尖介入二尖瓣夹合手术中的初步应用

Preliminary application of transesophageal echocardiography in transapical mitral valve repair with Memoclip

目的探讨经食管超声心动图(TEE)引导Memoclip经心尖导管二尖瓣夹合系统治疗二尖瓣中重度和重度反流的应用价值。方法前瞻性选取2021年12月至2022年10月合肥高新心血管病医院15例二尖瓣中重度或重度反流患者经心尖植入Memoclip系统。植入前采用TEE详细评估二尖瓣形态、瓣叶长度、反流程度、左室射血分数、肺静脉频谱形态等;术中TEE全程引导穿刺部位、夹合系统入路、调节过程及植入路径;植入后评估夹合器位置、夹合长度、残余反流、瓣口形态及平均压差。且手术全程监测有无并发症发生。结果15例患者中,12例各植入1枚夹合器,3例各植入2枚夹合器,术后即刻TEE和出院前经胸超声心动图(TTE)复查均为轻度残余反流,术中术后无并发症发生。术后1个月,TTE 13例反流维持在轻度,2例在中度范围。术后3个月,13例患者保持轻度,2例患者仍为中度。五个观察时间点二尖瓣最大反流面积差异有统计学意义(均P<0.05),术后即刻至术后3个月二尖瓣最大反流面积、二尖瓣最大跨瓣压差、二尖瓣口面积与术前相比显著减少(均P<0.001),瓣口无明显狭窄。结论Memoclip经心尖导管二尖瓣夹系统治疗二尖瓣中重度和重度反流患者,是安全、有效、易操作,TEE在围术期具有重要的引导和检测作用。

Objective To explore the value of transapical catheter of mitral valve repair(MVR)with Memoclip device in the management of moderate to severe and severe mitral regurgitation(MR)guided by transesophageal echocardiography(TEE).Methods Fifteen patients with moderate to severe and severe MR in Hefei High-tech Cardiovascular Hospital from December 2021 to October 2022 were prospectively selected.Mitral valve morphology and length,regurgitation severity,left ventricular ejection fraction and pulmonary venous Doppler spectra were carefully evaluated before MVR by TEE.Intraprocedural TEE was performed to guide the MVR including transseptal catheterization,alignment of the clip delivery system,assessment of leaflet capture,clip deployment,post-clip deployment assessment,and withdrawal of the clip delivery system.The position and coaptation length of the clips,the mitral orifice morphology,residual mitral valve regurgitation and pressure gradient were evaluated after MVR.Meanwhile,the complications were monitored throughout the procedure.Results Among the 15 patients,12 were implanted with 1 clip and 3 were implanted with 2 clips,respectively.No complications occurred.There were 13 patients with mild regurgitation and 2 showed to moderate mitral regurgitation 1 month later after MVR,and 13 remained mild and 2 maintained moderate regurgitation 3 months later.Significant differences were found in maximal MR area(MRA-max),maximal and mean mitral valve pressure gradient(MVPG-max,MVPG-mean)and mitral valve area(MVA)among the 5 observation time points(all P<0.05).MRA-max,MVA and MVPG-mean were significantly decreased immediately and 3 months after the procedure(P<0.001).No significant stenosis was found in mitral valve after MVR.Conclusions MVR with Memoclip is safe,effective,easy to operate in treating patients with moderate to severe and severe MR.TEE plays a key role in perioperative MVR with Memoclip through apical catheterization.