应用血管内超声评估经导管主动脉瓣置换术中冠状动脉阻塞风险12例回顾分析

Assessing the risk of coronary artery occlusion during transcatheter aortic valve replacement by intravascular ultrasound:a retrospectire analysis of 12 cases

目的 研究血管内超声(intravascular ultrasound,IVUS)评估经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)术中冠状动脉阻塞风险的可行性。方法 回顾性分析北部战区总医院自2020年4月至2023年11月12例经计算机断层扫描分析判断为冠状动脉阻塞风险高,接受TAVR治疗且术中应用IVUS评估冠状动脉开口堵塞可能性的患者。结果 共纳入12例术前CT分析冠状动脉堵塞风险高的患者,三叶式主动脉瓣9例,二叶式主动脉瓣3例。24条冠状动脉中,其中3条冠状动脉在球囊扩张的同时对冠状动脉开口实施IVUS检查,11条冠状动脉在植入人工瓣膜后实施IVUS检查。5条冠状动脉经IVUS检查后被判定为堵塞风险高而植入冠状动脉支架。结论IVUS对于TAVR术中或术后冠状动脉堵塞的风险评价有重要意义,尤其是在人工瓣膜植入术后,能准确预测冠状动脉堵塞风险。

Objective To investigate the feasibility of intravascular ultrasound(IVUS)in assessing the risk of coronary artery occlusion during transcatheter aortic valve replacement(TAVR).Methods A retrospective analysis was performed on 12 patients with high risk of coronary artery occlusion confirmed by computed tomography(CT)from April 2020 to November 2023 in General Hospital of Northern Theater Command,who were treated with TAVR and assessed by IVUS during the procedure for the possibility of coronary artery occlusion.Results A total of 12 patients with high risk of coronary artery occlusion determined by preoperative CT were enrolled,including 9 patients with tricuspid aortic valve and 3patients with bicuspid aortic valve.Among the 24 coronary arteries,IVUS was performed on the coronary ostium at the same time as balloon dilation in 3 coronary arteries,and in 11 coronary arteries IVUS was performed after transcatheter heart valve(THV)implantation.Five coronary arteries were determined to be at high risk of occlusion by IVUS examination and coronary stents were implanted.Conclusions IVUS is one of important modality for the risk assessment of coronary artery occlusion during or after TAVR,especially after THV implantation,which can accurately predict the risk of coronary artery occlusion.