2020 年第 12 期 第 15 卷

超声心动图对经导管主动脉瓣置换术效果的评价作用

Evaluation of echocardiography in transcatheter aortic valve implantation

作者：姚璐婵1科雨彤1张海波2刘巍3张纯1

英文作者：Yao Luchan1 Ke Yutong1 Zhang Haibo2 Liu Wei3 Zhang Chun1

单位：1首都医科大学附属北京安贞医院超声心动三部北京市心肺血管疾病研究所100029；2首都医科大学附属北京安贞医院心脏外科100029；3首都医科大学附属北京安贞医院心内十二病房100029

英文单位：1The Third Department of Echocardiography Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China； 2Department of Cardiovascular Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China； 3the 12th Ward， Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：主动脉瓣狭窄；主动脉瓣关闭不全；超声心动图；经导管主动脉瓣置换

英文关键词：Aorticstenosis；Aorticinsufficiency；Echocardiography；Transcatheteraorticvalveimplantation

• 摘要：

• 目的 探讨超声心动图对经导管主动脉瓣置换术（TAVI）的评价作用。方法  回顾性分析2019年5月至2020年3月于首都医科大学附属北京安贞医院因外科开胸主动脉瓣置换手术禁忌而行TAVI的主动脉瓣膜病变患者39例，其中主动脉瓣狭窄（AS）患者作为A组（17例），主动脉瓣关闭不全（AI）患者作为B组（10例），重度AS合并中重度AI患者作为C组（12例）。记录患者一般资料、术前合并症、操作成功率、术前及术后30 d的超声心动图参数、临床总成功率及随访结果。结果   3组患者年龄、性别、纽约心脏病协会心功能分级、高血压、糖尿病、高血脂、冠状动脉病变比例比较，差异均无统计学意义（均P>0.05）。3组操作成功率均为100%。A组术后30 d主动脉瓣上最大流速（AV Vmax）、最大跨瓣压差（PGmax）低于术前［(2.3±0.5)m/s比 (5.2±0.6)m/s、（21±10）mmHg（1 mmHg=0.133 kPa）比（109±25）mmHg］，主动脉瓣有效瓣口面积（AVA）大于术前［（1.62±0.46）cm2比（0.50±0.19）cm2］ ，差异均有统计学意义（均P<0.05）。B组术后30 d左心室舒张末期容积、收缩末期容积、主动脉瓣反流面积（AR area）、主动脉瓣反流缩流径（AR width）、主动脉瓣有效反流口面积（AR EROA）、主动脉瓣反流量（AR volume）均低于术前［（138±68）ml比（230±58）ml、（77±44）ml比（116±40）ml、（1.5±0.8）cm2比（11.4±2.1）cm2、（1.0±0.9）mm比（9.4±3.0）mm、（0.02±0.02）cm2比（0.54±0.21）cm2、（2.2±2.1）ml/搏比（136.3±53.9）ml/搏］（均P<0.05）。C组术后30 d AV Vmax、PGmax、AR area、AR width、AR EROA、AR volume均低于术前，AVA高于术前，差异均有统计学意义（均P<0.05）。临床总成功率为74.4%（29/39），随访1年内无患者死亡。结论  超声心动图可用于监测不同类型主动脉瓣膜疾病的心功能指标，对于TAVI手术效果的评估具有一定价值。

• Objective  To investigate the evaluation of echocardiography in transcatheter aortic valve implantation (TAVI). Methods From May 2019 to March 2020, 39 patients with aortic valve disease underwent TAVI due to contraindication of surgical aortic valve replacement in Beijing Anzhen Hospital, Capital Medical University were analyzed retrospectively, including aortic stenosis(AS) 17 cases（group A ）, aortic insufficiency (AI) 10 cases（group B）, and severe AS complicated with moderate and severe AI 12 cases(group C). The general data, preoperative complications, success rate of operation, echocardiography before and 30 d after operation, the total clinical success rate and follow-up results were recorded. Results There were no significant differences in age, gender, New York Heart Association cardiac function grade, and rates of hypertension, diabetes, hyperlipidemia and coronary artery disease among the three groups (all P>0.05). The rates of operation success in the three groups were 100%. At 30 d after operation the maximum supravalvular velocity (AV Vmax) and maximum pressure gradient (PGmax) in group A were lower than those before operation ［(2.3±0.5)m/s vs (5.2±0.6)m/s, (21±10)mmHg vs (109±25)mmHg］, and the aortic valve area (AVA) was larger than that before operation ［(1.62±0.46)cm2 vs (0.50±0.19)cm2］(all P<0.05). At 30 d after operation left ventricular end diastolic volume, left ventricular end systolic volume, aortic valve regurgitation area (AR area), aortic valve regurgitation width (AR width), aortic valve effective regurgitation orifice area (AR EROA) and aortic valve regurgitation volume （AR volume）in group B were lower than those before operation［（138±68）ml vs （230±58）ml,（77±44）ml vs （116±40）ml,（1.5±0.8）cm2 vs （11.4±2.1）cm2,（1.0±0.9）mm vs （9.4±3.0）mm,（0.02±0.02）cm2 vs （0.54±0.21）cm2,（2.2±2.1）ml/beat vs （136.3±53.9）ml/beat］ (all P<0.05). At 30 d after operation AV Vmax, PGmax, AR area, AR width, AR EROA and AR volume in group C were lower and AVA was higher than those beforeoperation, and the differences were statistically significant (all P<0.05). The total clinical success rate was 74.4% (29/39). There was no death within 1 year of follow-up. Conclusion Echocardiography can be used to monitor the cardiac function of different types of aortic valve disease. It has a certain value for the evaluation of the effect of TAVI surgery.