摘要
目的探讨CT应用于非径向支撑LuX-Valve三尖瓣置换术前评估的价值。方法连续入选2020年10月至2021年4月重度三尖瓣反流患者145例。采用256排或以上CT扫描,测量瓣膜置放相关指标,分析患者是否适合行瓣膜置换并选择瓣膜型号。结果术前CT测量排除病例49例,其中因瓣环大小不符直接排除8例,其余41例为综合瓣膜大小、形态、瓣膜固定及操作安全等因素排除。共计96例行经导管三尖瓣置换(TTVR)手术,其中6例中转外科手术,1例瓣膜中度反流,其余术中均无或轻度反流/瓣周漏,即时操作成功率92.7%。89例成功LuX-Valve置换病例中,26例瓣膜型号与三尖瓣测量直径相符,63例经过综合分析选择置入瓣膜型号大于直径测量型号,两组统计分析结果显示右心房的大小为加大瓣膜型号选择的主要影响因素。结论CT在TTVR术前筛查中有重要价值,对于LuX-Valve装置瓣膜型号选择,瓣环大小非唯一决定性因素,需综合评估多项测量指标。
Objective To evaluate the value of CT in preoperative assessment of tricuspid valve replacement with LuX-Valve.Methods 145 consecutive patients with severe tricuspid regurgitation from October 2020 to April 2021 were selected.The multi-slice spiral CT(256 slice and above)scans were used to measure related indicators.Then analyses were made to determine whether the patients were suitable for valves replacement and to select the appropriate valve model.Results 49 cases were excluded after CT measurements,including 8 cases because of the values of the valve annulus and the remaining 41 due to comprehensive indicators includes:valve annulus size and shape,fixation method and operational safety.A total of 96 TTVR operations were performed,of which 6 were treated with thoracic surgery,1 had moderate valve regurgitation,and the rest had no or mild regurgitation or paravalvular leaks.The operations showed a high success rate of 92.7%.After comprehensive analysis,it was found that among the 89 successful tricuspid valve replacements with LuX-Valve,26 cases had annulus models consistent with the measurements of the diameter from tricuspid annular circumferences,while the remaining 63 had valve models larger than the diameter measurements.The results indicate that the size of right atrium was statistically significant to the enlargement of the valve size.Conclusion CT has important application value in the preoperative screening of TTVR.For non-radial force LuX-Valve,the annulus size is not the only decisive factor,and the valve model should be comprehensively judged considering all the measurement indicators.
作者
杨嘉
代顺
章异
陈安
陈静文
胡新星
张蕾
Yang Jia;Dai Shun;Zhang Yi;Chen An;Chen Jingwen;Hu Xinxing;Zhang Lei(Department of Radiology,Shanghai General Hospital,Shanghai 201620,China;Department of Radiology,Tongren Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200050,China)
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2022年第6期332-337,共6页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
三尖瓣反流
经导管三尖瓣置换
CT
术前评估
Tricuspid regurgitation
Transcatheter tricuspid valve replacement
CT
Preoperative evaluation
