2025 年第 4 期 第 20 卷

不同病因中重度二尖瓣反流患者经导管缘对缘修复后1年左心逆向重构分析

Analysis of left ventricular reverse remodeling at 1 year after transcatheter edge-to-edge repair of moderate to severe mitral regurgitation in patients with different etiologies

作者：何静卢志南科雨彤刘新民苑飞姜正明张骞宋光远

英文作者：He Jing Lu Zhinan Ke Yutong Liu Xinmin Yuan Fei Jiang Zhengming Zhang Qian Song Guangyuan

单位：首都医科大学附属北京安贞医院心脏瓣膜病介入中心，北京100029

英文单位：Interventional Center of Valvular Heart Disease Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：经导管缘对缘修复术；退行性二尖瓣反流；功能性二尖瓣反流；左心逆向重构

英文关键词：Transcatheteredge-to-edgerepair;Degenerativemitralregurgitation;Functionalmitralregurgitation;Leftventricularreverseremodeling

• 摘要：

• 目的 评估不同病因中重度二尖瓣反流（MR）患者接受经导管缘对缘修复术(TEER)后1年左心逆向重构情况。方法 回顾性分析2021年6月至2023年11月在首都医科大学附属北京安贞医院心脏瓣膜病介入中心行TEER治疗的91例中重度MR患者的临床和超声心动图资料。根据病因分为退行性二尖瓣反流(DMR)组（70例）和功能性二尖瓣反流(FMR)组（21例）。收集临床基线资料及术前和术后1年复查的超声心动图数据。比较2组患者术后1年左心逆向重构情况和功能变化。结果 与DMR组相比，FMR组基线有效反流口面积、有效瓣口面积较小，左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)较大，左心室射血分数更小（均P＜0.05）。术后1年，2组患者左心室舒张末期内径、左心室收缩末期内径、LVEDV、LVESV、左心房内径均较术前减小，二尖瓣平均跨瓣压差较术前升高，纽约心脏病协会心功能分级明显改善(均P＜0.05)；正常左心室形态比例较基线增高［DMR组：31.4%（22/70）比20.0%(14/70)，FMR组：61.9%(13/21)比33.3%(7/21)］，左心室偏心性肥厚患者比例降低(均P＜0.05)。结论 对于不同病因的中重度MR患者，TEER治疗均可有效改善术后中期的MR反流程度，改善心功能，促进左心室逆向重构，并使部分患者恢复正常左心室形态。

• Objective To evaluate the left ventricular reverse remodeling at 1 year after transcatheter edge-to-edge repair(TEER) of moderate to severe mitral regurgitation (MR) in patients with different etiologies. Methods The clinical and echocardiographic data of 91 patients with moderate to severe MR Who underwent TEER treatment in the Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University from June 2021 to November 2023 were retrospectively analyzed. According to the etiology, the patients were divided into degenerative mitral regurgitation (DMR) group (70 cases) and functional mitral regurgitation (FMR) group (21 cases). Clinical baseline data and echocardiographic data before and 1 year after surgery were collected. Left ventricular reverse remodeling and functional changes were compared between the two groups one year after surgery. Results Compared with the DMR group, the effective regurgitation orifice area and effective valve orifice area in the FMR group were smaller, the left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) were larger, and the left ventricular ejection fraction was smaller (all P＜0.05). One year after operation, the left ventricular end-diastolic diameter, left ventricular end-systolic diameter, LVEDV, LVESV and left atrial diameter of the two groups were lower than those before operation, the mean mitral valve pressure gradient was higher than that before operation, and the New York Heart Association heart function classification was significantly improved (all P＜0.05). The proportion of normal left ventricular shape was increased compared with baseline ［DMR group: 31.4% (22/70) vs 20.0%(14/70), FMR group: 61.9%(13/21) vs 33.3%(7/21)］, and the proportion of eccentric left ventricular hypertrophy was decreased (all P＜0.05). Conclusions  For patients with moderate to severe MR of different etiologies, TEER treatment can effectively improve the degree of MR Regurgitation in the mid-term after operation, improve cardiac function, promote left ventricular reverse remodeling, and restore normal left ventricular morphology in some patients.