Background: Surgical method was introduced for enhancement of prosthetic valve insertion and overcoming difficulties ensourcing from prosthesis-patient mismatch. Methods: Twenty-two patients that underwent aortic valv...Background: Surgical method was introduced for enhancement of prosthetic valve insertion and overcoming difficulties ensourcing from prosthesis-patient mismatch. Methods: Twenty-two patients that underwent aortic valve replacement between January 2005 and July 2009 were included in this prospective study. In these patients, the insertion of prosthesis larger than the annulus diameter was attempted after the application of an external pressure that increased the transverse axis diameter of the aortic annulus. The postoperative results and complications were assessed. Results: This surgical method was performed on 22 patients (16 males, 6 females, mean age: 52.2 ± 15.8 years) during the valve replacement. In 12 patients (55%), replacement of proper sized aortic valve compliant to their surface area was accomplished, while the insertion of a proper valve could not be achieved in 10 (45%) of the patients. No perioperative mortality or complications related to the procedure were reported. Conclusion: Increasing the transverse diameter of aortic valve may not only facilitate the insertion of a prosthetic valve but also aid in overcoming prosthesis-patient mismatch. Further studies on larger series are necessary to document the actual effectively and precise selection criteria for application of this method.展开更多
目的评估主动脉瓣复合体(AVC)不同区域钙化分布密度对应用国产自膨式瓣膜(SEV)行经导管主动脉瓣置换(TAVR)术后新发传导障碍(CB)的影响。方法纳入2016年1月~2022年12月接受国产Venus-A人工瓣膜置换术的重度主动脉瓣狭窄患者共73例,根据...目的评估主动脉瓣复合体(AVC)不同区域钙化分布密度对应用国产自膨式瓣膜(SEV)行经导管主动脉瓣置换(TAVR)术后新发传导障碍(CB)的影响。方法纳入2016年1月~2022年12月接受国产Venus-A人工瓣膜置换术的重度主动脉瓣狭窄患者共73例,根据术后是否出现新发CB分为CB组和无CB组,比较两组基线数据、影像资料和手术数据情况。单因素、多因素Logistic回归分析TAVR术后新发CB的独立危险因素。应用受试者工作特征(ROC)曲线及DeLong检验,分析各危险因素及联合指标预测效能。结果73例TAVR患者中,18例(24.7%)术后新发CB。CB组具有更大的植入深度(6.77±2.45 mm vs 5.11±3.28 mm,P=0.027),且室间隔膜部长度与植入深度差值(MSID)明显小于无CB组(0.68±3.49 mm vs 2.82±3.88 mm,P=0.036)。钙化分布方面,CB组设备着陆区(DLZ)左冠窦(LCS)的钙化分布密度明显高于无CB组[10.34(2.50,48.35)×102 mm^(3)/mm^(2)vs 3.27(0.00,13.79)×102 mm^(3)/mm^(2),P=0.026]。多因素Logistic分析发现,DLZ-LCS钙化分布密度、MSID是TAVR术后新发CB的独立危险(保护)因素。ROC曲线显示,MSID、DLZ-LCS钙化分布密度预测CB的曲线下面积(AUC)分别为0.775和0.716,联合指标预测具有最大的AUC(0.890),与单独指标比较差异均有统计学意义(P=0.041 vs MSID;P=0.027 vs DLZ-LCS钙化分布密度)。结论DLZ-LCS钙化分布密度是国产SEV的TAVR术后新发CB的独立危险因素,联合MSID可以有效预测TAVR术后的传导并发症。展开更多
目的通过对比国产半自动术前CT分析软件Anythink与3mensio应用于经导管主动脉瓣置换术前测量的数据,评价Anythink软件测量主动脉根部参数的一致性与短期预后间的关联性。方法回顾性纳入2016年12月~2022年2月于中国人民解放军总医院行TAV...目的通过对比国产半自动术前CT分析软件Anythink与3mensio应用于经导管主动脉瓣置换术前测量的数据,评价Anythink软件测量主动脉根部参数的一致性与短期预后间的关联性。方法回顾性纳入2016年12月~2022年2月于中国人民解放军总医院行TAVR手术的67例患者,由一名完成专业培训的心内科医生分别使用新型半自动分析软件Anythink与“金标准”3mensio软件同步重建主动脉根部模型,测量主动脉瓣环及周围结构,分析两种软件结果的相关性及一致性;由两名独立医生应用Anythink软件重复测量,评价Anythink对于同一研究对象测量的可重复性;依据Anythink和3mensio软件测量结果选取瓣膜型号,分析两软件在实际用于指导临床瓣膜选择时的异同。结果Anythink与3mensio测量的左冠脉开口高度(13.37±3.35 mm vs 13.19±3.19 mm)、右冠脉开口高度(15.45±2.89 mm vs 15.75±2.93mm)、瓣环直径(24.0±2.2 mm vs 23.9±2.3 mm)、瓣环面积(450.6±88.3 mm2 vs 447.5±90.0 mm2)、瓣环周长(76.5±7.2 mm vs 76.1±7.6 mm)、主动脉瓣环与水平面夹角(53.5°±10.0°vs 51.1°±9.7°)差异均无统计学意义(P>0.05)。Pearson相关分析结果显示,两软件测量数据呈正相关(r=0.884~0.981,P<0.01);Anythink测量瓣环数据组内相关系数ICC=0.894~0.992,组间相关系数ICC=0.651~0.954;Anythink与3mensio依据平均直径、面积直径、周长直径的选取瓣膜型号Kappa检验值分别为0.886、0.796、0.775;依据两次Anythink测量的平均直径、面积直径、周长直径选取瓣膜型号组内Kappa值为0.819、0.841、0.795,组间Kappa值为0.812、0.812、0.768。与患者短期预后关联性部分,在出现术后瓣周漏的患者中,Anythink测量面积直径相较于3mensio软件推荐的瓣膜型号略大,而在出现术后新发传导阻滞的患者中,Anythink推荐的瓣膜型号略小。结论国产半自动TAVR术前CT分析软件Anythink与3mensio软件在主动脉根部参数测量方面具有较好的�展开更多
Background Accurate evaluation of coronary artery,aortic valve annulus diameter （AVAD）,and cardiac function in patients with aortic valve disease is of great significance for surgical strategy.In this study,we explo...Background Accurate evaluation of coronary artery,aortic valve annulus diameter （AVAD）,and cardiac function in patients with aortic valve disease is of great significance for surgical strategy.In this study,we explored the preoperative evaluation of low-dose sequence （MinDose sequence） scan of dual-source CT （DSCT） for those patients.Methods Forty patients suspected for aortic valve disease （the experimental group） underwent MinDose sequence of DSCT to observe coronary artery,AVAD,and left ventricular ejection fraction （LVEF）.Another 33 subjects suspected for coronary artery disease （the control group） underwent conventional retrospective electrocardiographically-gated sequence of DSCT.Two-dimensional transthoracic echocardiography （2D-TTE） and four-dimensional transthoracic echocardiography （4D-TTE） were applied in the experimental group to measure AVAD and LVEF and compared with MinDose-DSCT.Results There was a strong correlation between LVEFs measured by 2D-TTE and MinDose-DSCT （r=0.87,P ＜0.01）,as well as between 4D-TTE and MinDose-DSCT （r=0.90,P ＜0.01）.AVAD measured by MinDose-DSCT was in good agreement with corresponding measurements by 2D-TTE （r=0.90,P ＜0.01）.The effective dose in the experimental group was 63.54％ lower than that in the control group.Conclusions MinDose sequence of DSCT with a low radiation dose serving as a one-stop preoperative evaluation makes effective assessment of the coronary artery,AVAD,and LVEF for patients with aortic valve disease.展开更多
文摘Background: Surgical method was introduced for enhancement of prosthetic valve insertion and overcoming difficulties ensourcing from prosthesis-patient mismatch. Methods: Twenty-two patients that underwent aortic valve replacement between January 2005 and July 2009 were included in this prospective study. In these patients, the insertion of prosthesis larger than the annulus diameter was attempted after the application of an external pressure that increased the transverse axis diameter of the aortic annulus. The postoperative results and complications were assessed. Results: This surgical method was performed on 22 patients (16 males, 6 females, mean age: 52.2 ± 15.8 years) during the valve replacement. In 12 patients (55%), replacement of proper sized aortic valve compliant to their surface area was accomplished, while the insertion of a proper valve could not be achieved in 10 (45%) of the patients. No perioperative mortality or complications related to the procedure were reported. Conclusion: Increasing the transverse diameter of aortic valve may not only facilitate the insertion of a prosthetic valve but also aid in overcoming prosthesis-patient mismatch. Further studies on larger series are necessary to document the actual effectively and precise selection criteria for application of this method.
文摘目的评估主动脉瓣复合体(AVC)不同区域钙化分布密度对应用国产自膨式瓣膜(SEV)行经导管主动脉瓣置换(TAVR)术后新发传导障碍(CB)的影响。方法纳入2016年1月~2022年12月接受国产Venus-A人工瓣膜置换术的重度主动脉瓣狭窄患者共73例,根据术后是否出现新发CB分为CB组和无CB组,比较两组基线数据、影像资料和手术数据情况。单因素、多因素Logistic回归分析TAVR术后新发CB的独立危险因素。应用受试者工作特征(ROC)曲线及DeLong检验,分析各危险因素及联合指标预测效能。结果73例TAVR患者中,18例(24.7%)术后新发CB。CB组具有更大的植入深度(6.77±2.45 mm vs 5.11±3.28 mm,P=0.027),且室间隔膜部长度与植入深度差值(MSID)明显小于无CB组(0.68±3.49 mm vs 2.82±3.88 mm,P=0.036)。钙化分布方面,CB组设备着陆区(DLZ)左冠窦(LCS)的钙化分布密度明显高于无CB组[10.34(2.50,48.35)×102 mm^(3)/mm^(2)vs 3.27(0.00,13.79)×102 mm^(3)/mm^(2),P=0.026]。多因素Logistic分析发现,DLZ-LCS钙化分布密度、MSID是TAVR术后新发CB的独立危险(保护)因素。ROC曲线显示,MSID、DLZ-LCS钙化分布密度预测CB的曲线下面积(AUC)分别为0.775和0.716,联合指标预测具有最大的AUC(0.890),与单独指标比较差异均有统计学意义(P=0.041 vs MSID;P=0.027 vs DLZ-LCS钙化分布密度)。结论DLZ-LCS钙化分布密度是国产SEV的TAVR术后新发CB的独立危险因素,联合MSID可以有效预测TAVR术后的传导并发症。
文摘目的通过对比国产半自动术前CT分析软件Anythink与3mensio应用于经导管主动脉瓣置换术前测量的数据,评价Anythink软件测量主动脉根部参数的一致性与短期预后间的关联性。方法回顾性纳入2016年12月~2022年2月于中国人民解放军总医院行TAVR手术的67例患者,由一名完成专业培训的心内科医生分别使用新型半自动分析软件Anythink与“金标准”3mensio软件同步重建主动脉根部模型,测量主动脉瓣环及周围结构,分析两种软件结果的相关性及一致性;由两名独立医生应用Anythink软件重复测量,评价Anythink对于同一研究对象测量的可重复性;依据Anythink和3mensio软件测量结果选取瓣膜型号,分析两软件在实际用于指导临床瓣膜选择时的异同。结果Anythink与3mensio测量的左冠脉开口高度(13.37±3.35 mm vs 13.19±3.19 mm)、右冠脉开口高度(15.45±2.89 mm vs 15.75±2.93mm)、瓣环直径(24.0±2.2 mm vs 23.9±2.3 mm)、瓣环面积(450.6±88.3 mm2 vs 447.5±90.0 mm2)、瓣环周长(76.5±7.2 mm vs 76.1±7.6 mm)、主动脉瓣环与水平面夹角(53.5°±10.0°vs 51.1°±9.7°)差异均无统计学意义(P>0.05)。Pearson相关分析结果显示,两软件测量数据呈正相关(r=0.884~0.981,P<0.01);Anythink测量瓣环数据组内相关系数ICC=0.894~0.992,组间相关系数ICC=0.651~0.954;Anythink与3mensio依据平均直径、面积直径、周长直径的选取瓣膜型号Kappa检验值分别为0.886、0.796、0.775;依据两次Anythink测量的平均直径、面积直径、周长直径选取瓣膜型号组内Kappa值为0.819、0.841、0.795,组间Kappa值为0.812、0.812、0.768。与患者短期预后关联性部分,在出现术后瓣周漏的患者中,Anythink测量面积直径相较于3mensio软件推荐的瓣膜型号略大,而在出现术后新发传导阻滞的患者中,Anythink推荐的瓣膜型号略小。结论国产半自动TAVR术前CT分析软件Anythink与3mensio软件在主动脉根部参数测量方面具有较好的�
文摘Background Accurate evaluation of coronary artery,aortic valve annulus diameter （AVAD）,and cardiac function in patients with aortic valve disease is of great significance for surgical strategy.In this study,we explored the preoperative evaluation of low-dose sequence （MinDose sequence） scan of dual-source CT （DSCT） for those patients.Methods Forty patients suspected for aortic valve disease （the experimental group） underwent MinDose sequence of DSCT to observe coronary artery,AVAD,and left ventricular ejection fraction （LVEF）.Another 33 subjects suspected for coronary artery disease （the control group） underwent conventional retrospective electrocardiographically-gated sequence of DSCT.Two-dimensional transthoracic echocardiography （2D-TTE） and four-dimensional transthoracic echocardiography （4D-TTE） were applied in the experimental group to measure AVAD and LVEF and compared with MinDose-DSCT.Results There was a strong correlation between LVEFs measured by 2D-TTE and MinDose-DSCT （r=0.87,P ＜0.01）,as well as between 4D-TTE and MinDose-DSCT （r=0.90,P ＜0.01）.AVAD measured by MinDose-DSCT was in good agreement with corresponding measurements by 2D-TTE （r=0.90,P ＜0.01）.The effective dose in the experimental group was 63.54％ lower than that in the control group.Conclusions MinDose sequence of DSCT with a low radiation dose serving as a one-stop preoperative evaluation makes effective assessment of the coronary artery,AVAD,and LVEF for patients with aortic valve disease.
