摘要
目的:探讨三维经食道超声心动图(3D-TEE)在经导管三尖瓣置换术(TTVR)中的早期应用经验。方法:连续纳入2019年8月至2021年6月期间在中国人民解放军空军军医大学第一附属医院(西京医院)因重度三尖瓣反流且外科手术高危而行TTVR的患者15例,其中男性5例,女性10例。所有患者均在3D-TEE及数字减影血管造影引导下在病变三尖瓣位置置入第一代LuX瓣膜。术后即刻应用3D-TEE评估手术效果,并与术前结果进行对比研究。结果:15例患者均在3D-TEE引导下经右心房入路成功置入第一代LuX瓣膜。3D-TEE在术前可对三尖瓣结构、反流机制及反流程度行进一步评估。在手术过程中应用3D-TEE均能较好地观察三尖瓣环、输送系统位置、轴向及人工瓣膜运动。对于人工瓣膜前瓣夹持件的显示略显不足,9例可显示1枚夹持件,6例可显示2枚夹持件,15例患者室间隔锚定键均可显示。术后即刻3D-TEE显示:人工瓣膜位置良好,三尖瓣反流程度较术前明显减少(P<0.001);三尖瓣峰值血流速度、三尖瓣跨瓣最大压差、三尖瓣平均血流速度、三尖瓣跨瓣平均压差、三尖瓣血流速度时间积分与术前比差异均无统计学意义(P均>0.05);左心室射血分数较术前降低(P=0.021);无中量及以上瓣周漏发生。结论:在TTVR术中,3D-TEE可实时监测整个手术流程,并对于瓣叶夹持件的准确定位和室间隔锚定装置稳定性的评估有重要作用,可即刻评估术后疗效,是第一代LuX瓣膜介入术中不可或缺的影像学监测手段。
Objectives:To explore the early application experience of three-dimensional transesophageal echocardiography(3D-TEE)in transcatheter tricuspid valve replacement(TTVR).Methods:15 Patients with severe tricuspid valve regurgitation at high surgical risk who planned to undergo TTVR in The First Affiliated Hospital of Chinese People’s Liberation Army Air Force Medical University from August 2019 to June 2021 were included in this study.All patients received the first generation LuX valve implantation guided by 3D-TEE and digital subtraction angiography(DSA)at the diseased tricuspid valve position.3D-TEE was used immediately after procedure to evaluate the effect,and the results were compared with those before procedure.Results:All 15 patients(5 males and 10 females)were successfully implanted with the LuX valves through the right atrial approach guided by 3D-TEE.3D-TEE can be used to further evaluate the tricuspid valve structure,regurgitation mechanism,and degree of regurgitation before the procedure.Intraoperative 3D-TEE display rate of interventional valve delivery system and interventricular septal anchor was 100%.9 patients could clearly locate 1 grasper,and 6 patients could clearly locate 2 graspers.The position of the prosthetic valve was good and the tricuspid regurgitation was significantly reduced(P<0.001)immediately after the procedure.There was no significant difference between the peak velocity,maximum gradient,mean velocity,mean gradient,and flow velocity time integral of the tricuspid from pre-procedure(all P>0.05).Left ventricular ejection fraction was lower than that preoperative(P=0.021),and no moderate or above perivalvular leakage was observed.Conclusions:In TTVR procedure,3D-TEE could monitor the entire process in real time,thus play an important role in accurate positioning the graspers and evaluating the stability of the ventricular septal anchoring device.It is not only the key to ensure the success of the TTVR procedure,but also can immediately evaluate the postoperative results.3D-TEE is an
作者
孙艳丹
孟欣
白炜
李昱茜
曹亮
刘丽文
杜蒙蒙
杨剑
刘洋
金屏
SUN Yandan;MENG Xin;BAI Wei;LI Yuxi;CAO Liang;LIU Liwen;DU Mengmeng;YANG Jian;LIU Yang;JIN Ping(Department of Ultrasound,The First Affiliated Hospital of Chinese People's Liberation Army Air Force Medical University,Xi'an,710032,China;Department of Ultrasound,The Chinese People's Liberation Army 986th Hospital of the Air Force,Xi'an,710054,China;Department of Cardiovascular Surgery,The First Affiliated Hospital of Chinese People's Liberation Army Air Force Medical University,Xi'an,710032,China)
出处
《中国循环杂志》
CSCD
北大核心
2023年第9期917-922,共6页
Chinese Circulation Journal
关键词
经导管三尖瓣置换术
经食道超声心动图
三尖瓣反流
超声心动图
transcatheter tricuspid valve replacement
transesophageal echocardiography
tricuspid regurgitation
echocardiography
