摘要
目的应用术中经食管超声心动图(TEE)预测二尖瓣成形术(MVP)后并发收缩期前向运动(SAM)风险,并探讨其应用价值。方法回顾性分析郑州大学第一附属医院2016年8月至2020年5月215例因二尖瓣退行性病变行MVP患者的资料。其中182例未发生SAM(无SAM组),33例发生SAM(SAM组)。根据SAM的生理学基础,于体外循环开始前及心脏复跳即刻测量并比较SAM组与无SAM组各参数的差异,包括左房内径(LAD)、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、左室射血分数(LVEF)、室间隔基底段厚度(basal-IVDd)、左室后壁厚度(LVPW)、左室流出道内径(LVOTD)、左室流出道峰值流速(LVOT-Vmax)、左室流出道压力阶差(LVOTG)、二尖瓣口峰值流速(MV-Vmax)、二尖瓣口平均跨瓣压差(MVG-mean)、二尖瓣反流面积(MR-area)、主动脉瓣下室间隔成角(左心室长轴和主动脉长轴角)、二尖瓣前叶长度、二尖瓣后叶长度、二尖瓣前后叶长度比值、二尖瓣前后瓣膜接合点与室间隔距离(c-sept)、二尖瓣环径、主动脉-二尖瓣夹角(AMA)。筛选影响MVP术后并发SAM的独立风险因素。结果①与无SAM组相比,SAM组术前LVEDD、LVESD、二尖瓣前后叶长度比值、c-sept、AMA变小(均P<0.05),basal-IVDd、LVEF、二尖瓣后叶长度、主动脉瓣下室间隔成角增大(均P<0.05);②与"缘对缘"技术应用前相比,SAM组矫正术后,LVOT-Vmax从(4.31±2.26)m/s下降到(2.55±1.39)m/s,LVOTG从(43.58±10.89)mmHg下降到(23.36±12.76)mmHg,MVG-mean从(0.46±0.33)mmHg上升到(2.27±0.43)mmHg,MR-area从(3.52±0.79)cm2减少到(0.96±0.57)cm2(均P<0.05);③多因素Logistic回归分析显示,发生SAM的独立危险因素为LVEDD<45.430 mm(OR=0.267,95%CI=0.084~0.847)、IVDd>14.870 mm(OR=12.049,95%CI=1.619~89.661)、二尖瓣前后叶长度比值>1.371(OR=0.159,95%CI=0.045~0.562)、主动脉瓣下室间隔成角>62.330°(OR=18.246,95%CI=2.824~117.896)、c-sept<23.965 mm(OR=0.177,95%CI=0.05~0.628)、AMA<123.730°(OR=0.1
Objective To predict the risk of systolic anterior motion(SAM)after mitral valvuloplasty(MVP)by intraoperative transesophageal echocardiography(TEE)and its diagnostic value.Methods From August 2016 to May 2020,215 patients with mitral valve degeneration underwent MVP,including 182 patients without SAM(non-SAM group),and 33 patients with SAM(SAM group).TEE examination was performed immediately after operation to determine whether SAM phenomenon was relieved.According to the physiological basis of SAM,before cardiopulmonary bypass(CPB)and immediately after CPB,the parameters of SAM group and non-SAM group were measured and compared,including left atrial dimension(LAD),left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),left ventricular ejection fraction(LVEF),basal septal diameter(basal-IVDd),left ventricular posterior wall thickness(LVPW),left ventricular outflow tract diameter(LVOTD),left ventricular outflow tract maximum velocity(LVOT-Vmax),left ventricular outflow tract pressure gradient(LVOTG),mitral valve maximum velocity(MV-Vmax),mitral valve mean pressure gradient(MVG-mean),mitral regurgitation area(MR-area),bulging subaortic septum,anterior leaflet length,posterior leaflet length,ratio between the lengths of the anterior and posterior leaflets,coaptation-septum distance(c-sept),nnular diameter of mitral valve,aorto-mitral angle(AMA)to screen the independent risk factors of SAM after MVP.Results①Compared with the non-SAM group,LVEDd,LVESD,ratio between the length of the anterior and posterior leaflets,c-sep and AMA decreased in SAM group(all P<0.05),while basal-IVDd,LVEF,posterior leaflet length and bulging subaortic septum increased in SAM group(all P<0.05).②Compared with that before the"edge to edge"technique,LVOT-Vmax decreased from(4.31±2.26)m/s to(2.55±1.39)m/s,LVOTG decreased from(43.58±10.89)mmHg to(23.36±12.76)mmHg,MVG-mean increased from(0.46±0.33)mmHg to(2.27±0.43)mmHg,and MR-area increased from(3.52±0.79)cm2 to(0.96±0.57)cm2(all P<0.05).③Mult
作者
赵娜
齐清华
杨娟
杜江川
侯苏芸
王红鹄
张瑞芳
Zhao Na;Qi Qinghua;Yang Juan;Du Jiangchuan;Hou Suyun;Wang Honghu;Zhang Ruifang(Department of Ultrasound,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2021年第2期105-111,共7页
Chinese Journal of Ultrasonography
