摘要
目的初步探讨经食管超声心动图(transesophageal echocardiography,TEE)引导经导管DragonFly?系统缘对缘修复治疗三尖瓣反流(tricuspid regurgitation,TR)的价值。方法选取2020年12月至2021年1月在浙江大学医学院附属第二医院就诊的5例外科手术高危、术前TEE确诊为重度以上功能性TR患者行经导管DragonFly缘对缘修复术。TEE详细评估三尖瓣解剖、反流的起源及病因;术中在TEE引导下应用DragonFly系统行三尖瓣缘对缘修复术,DragonFly夹释放后经TEE即刻评估手术效果并与术前TEE相比较。结果5例患者共植入10枚DragonFly夹(2例患者3枚,1例患者2枚,2例患者1枚),其中1例患者3枚夹子中的1枚释放瞬间隔瓣单侧脱落,另9枚夹子位置及固定良好。TEE即刻评估TR反流量,3例患者减为轻度,2例减为中度,三维彩色血流定量评估反流颈口面积较术前减低[(0.93±0.26)cm2对(0.20±0.11)cm2]。5例患者均未发生三尖瓣严重损伤、心包压塞、血栓栓塞等并发症。结论TEE在DragonFly?缘对缘修复治疗TR手术全程中起着重要的引导、监测作用。
Objective To explore the value of transesophageal echocardiography(TEE)guidance for transcatheter DragonFly™system edge-to-edge tricuspid regurgitation(TR)repair.Methods Five cases who were chosen in the Second Affiliated Hospital,Zhejiang University School of Medicine from December 2020 to January 2021 with surgical high-risk and severe functional TR underwent transcatheter DragonFly edge-to-edge repair with the guidance of TEE.Preoperative TEE was used to evaluate the tricuspid valve anatomy and the origin and etiology of regurgitation in detail;intra-procedure guidance of TEE was performed during the DragonFly system for tricuspid valve edge-to-edge repair intervention and after release of the DragonFly clip,the effect of surgery was assessed immediately and compared with pre-procedure TEE.Results A total of 10 DragonFly clips were implanted in 5 patients(3 in each of patients,2 in 1 patient,and 1 in each of patients).One of the 3 clips in 1 patient fell off unilaterally from the septal valve after release,and the other 9 clips were well positioned and fixed.Immediately post-operation assessment by TEE depicted the TR in 3 patients declined to mild and 2 to moderate.The vena contracta area by using three-dimensional color blood flow quantitative assessment was reduced[(0.93±0.26)cm2 vs(0.20±0.11)cm2].No complications such as serious tricuspid valve injury,pericardial tamponade,thromboembolism occurred in the 5 patients.Conclusions TEE plays an important role in guiding and monitoring transcatheter DragonFly system edge-to-edge TR repair during the entire procedure.
作者
蒲朝霞
刘先宝
林心平
李华俊
王力涵
王建安
黄朝旭
Pu Zhaoxia;Liu Xianbao;Lin Xinping;Li Huajun;Wang Lihan;Wang Jian′an;Huang Zhaoxu(Department of Cardiology,Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2021年第10期843-847,共5页
Chinese Journal of Ultrasonography
基金
浙江省重点研发计划(2021C03097)。
关键词
超声心动描记术
经食管
三尖瓣反流
介入治疗
Echocardiography,transesophageal
Tricuspid valve regurgitation
Interventional treatment
