重度主动脉瓣狭窄行瓣膜置换术后左室流出道流速变化特征分析

目的分析重度主动脉瓣狭窄患者行瓣膜置换术后左室流出道(LVOT)流速变化特征。方法选取重度主动脉瓣狭窄行主动脉瓣置换术的患者114例,根据术后左室流出道流速变化情况分为流速增幅≥50%组(A组45例)和流速无明显增高组(B组69例),两组分别于术前3 d、术后7 d、3个月及6个月行超声心动图检查,测量左室舒张末期内径(LVEDD)、室间隔厚度及LVOT流速,并对其结果进行对比分析。术前判断主动脉瓣是否合并瓣叶畸形,术后记录人工瓣膜的性质,分析其对LVOT流速变化的影响。结果术前3 d、术后7 d及3个月两组LVEDD和室间隔厚度与LVEDD比值比较差异均有统计学意义(均P<0.05),术后6个月比较差异无统计学意义。两组术前主动脉瓣是否合并瓣叶畸形及术后人工瓣膜性质比较差异无统计学意义。结论 LVEDD较小、室间隔厚度与LVEDD比值较大时,主动脉瓣狭窄患者行瓣膜置换术后LVOT流速增快发生率高;LVOT流速变化呈先增加后降低的趋势,多于术后6个月恢复正常。     

超声心动图评价二叶式AVR术后心脏结构与功能变化

目的应用超声心动图评估主动脉瓣病变患者在主动脉人工瓣置换术(AVR)术后心脏结构与功能变化。方法选取AVR术后患者77例,根据术前诊断分为3组,AI组(单纯主动脉辯关闭不全)27例,AS组(单纯主动脉瓣狭窄)20例,BAV组(二叶式主动脉瓣膜病)30例,同时选取健康体检者25例作为对照组。超声随访AVR患者4年,采集患者的主动脉窦部内径(Ao-s)、升主动脉内径(Ao-asc),左室舒张末期内径(LVDd)、左室收缩末期内径(LVDs),室间隔舒张期厚度(Ivsd),左室后壁舒张期厚度(LVPWd)、左室射血分数(LVEF)、左室短轴缩短率(FS)并进行对比分析。结果与对照组比较,手术前BAV组和AI组患者的Ao-s、Ao-asc、LVDd、LVDs、IVSd、LVPWd均升高,LVEF、FS均降低;AS组患者的Ao-asc、LVDd、IVSd、LVPWd均升高。术后3个月,BAV组患者的LVDd、LVDs均降低,AI组患者的Ao-s、LVDd、LVDs均降低。BAV患者在4年的随访中Ao-s、Ao-asc有扩张趋势,术后4年与术后3个月比较,Ao-s、Ao-asc增宽;AS、AI患者在4年的随访中,Ao-s、Ao-asc变化无明显差异。结论AVR能够有效阻止BAV患者的心室重构,但术后依然有发生升主动脉扩张的概率,因此应定期进行超声心动图随访关注心脏及大血管变化。     

超声心动图在经导管主动脉瓣置换术前评估与术后随访中的应用价值

目的探讨超声心动图在评估经导管主动脉瓣置换（TAVR）术前与术后心脏结构和功能改变中的应用价值。 方法回顾性选取2014年9月至2019年7月在复旦大学附属中山医院心内科行TAVR的重度主动脉瓣狭窄（SAS）患者47例。所有患者均于术前及术后6个月行经胸超声心动图检查并记录常规超声心动图参数和主动脉瓣相关参数,包括左心室收缩末期内径（LVESD）、左心室舒张末期内径（LVEDD）、室间隔厚度（IVST）、后壁厚度（PWT）、肺动脉收缩压（PASP）、主动脉瓣最大跨瓣压差（AVPGmax）、主动脉瓣平均跨瓣压差（AVPGmean）、主动脉瓣有效瓣口面积（AVA）、左心室射血分数（LVEF）、主动脉根部内径（AORD）、左心房内径（LAD）,分析TAVR术前与术后的超声心动图参数变化。 结果与术前相比,术后47例患者的LVESD、IVST、PWT、PASP、AVPGmax、AVPGmean均明显减小,差异均有统计学意义（P均＜0.05）;AVA和LVEF均明显变大,差异均有统计学意义（P均＜0.05）。术后合并二尖瓣反流中度及以上或三尖瓣反流中度及以上的患者较术前明显减少（8例vs 3例,7例vs 2例）。 结论TAVR可纠正主动脉瓣狭窄,改善患者心功能。超声心动图相关参数有助于TAVR术后人工瓣膜及患者心脏结构功能的随访评估。     

心脏瓣膜置换术前后对多普勒Tei指数影响的研究

目的本研究应用彩色多普勒超声技术，对二尖瓣及主动脉瓣置换术前后Tei指数进行检测，旨在观察心脏瓣膜置换术前后Tei指数的变化，评价瓣膜功能不全对Tei指数的影响。方法选取86例进行主动脉瓣或二尖瓣置换术的患者[其中21例主动脉瓣狭窄（AS），17例主动脉瓣关闭不全（AR），28例二尖瓣狭窄（MS），20例二尖瓣关闭不全（MR）]。分别于术前1周至一个月、术后1周至1个月，应用经胸超声多普勒技术测量患者的左室射血分数（LVEF）、左室短轴缩短率（FS）、左室舒张末内径（LVDd）、左室收缩末内径（LVDs）、左房内径（LAD）及Tei指数。结果主动脉瓣狭窄、主动脉瓣关闭不全及二尖瓣狭窄患者术后Tei指数都有不同程度增加，差异均有显著性意义（P〈0．01），二尖瓣关闭不全患者术后Tei指数反而降低，但差异无显著性意义（P〉0．05）。其余测量指标手术前后也存在不同程度的差异。结论心脏瓣膜置换术后Tei指数有明显的变化，尤其在主动脉瓣狭窄患者。因此在评价瓣膜病患者的左心室功能时应考虑到瓣膜功能不全对Tei指数的影响。     

经导管主动脉瓣置入术对重度主动脉瓣狭窄合并不同程度二尖瓣返流患者的影响

目的 分析经导管主动脉瓣置入术（TAVI）对主动脉瓣狭窄（AS）合并不同程度二尖瓣返流（MR）患者的影响。方法 回顾性选取2020年4月至2023年5月就诊于河南省胸科医院重度主动脉瓣狭窄并行TAVI手术的患者180例，按照患者是否合并MR及MR严重程度分为A组（无返流+轻度返流）、B组（中度+重度返流）。比较两组术前与术后心脏结构及功能的变化，以及TAVI手术在两组患者中的效果差异。结果 两组患者术后主动脉瓣最大跨瓣压差即主瓣峰压差（AVPG）、主动脉瓣跨瓣峰流速即主瓣峰流速（AVPV）较术前均有改善（P <0.05），但其改善在两组之间差异无统计学意义（P> 0.05）。合并二尖瓣中重度返流组左心房内径（LAD）[39.00(37.00,42.00) mm]、左室舒张末期内径（LVEDD）[47.00(41.00,58.00)mm]、二尖瓣返流面积（MR）[2.90(2.40,4.70)cm2]及NT-ProBNP [2 567.80(1 196.87,3 344.90)pg/mL]均低于术前[41.00(38.00,48.00)mm]、[55.00(44.00,60....     

伴左室扩大和左室收缩功能降低的重度主动脉瓣狭窄患者行瓣膜置换术的疗效评价

目的评价单纯重度主动脉瓣狭窄合并左室扩大和左室射血分数减低及左心衰的患者行主动脉瓣置换术后的临床疗效和心功能改变。方法采集因单纯重度主动脉瓣狭窄（AS）（瓣口面积〈1．0cm^2）伴左室扩大、左室射血分数减低和左心衰而行主动脉瓣置换术的患者15例。术前二维超声心动图测量左室舒张末期内径（LVDd）、左室后壁厚度（PWTd）和室间隔厚度（IVSTd）,计算左室重量指数（LVMI）,Simpson法测量LVEF以及连续多普勒测量主动脉瓣跨瓣血流速度和最大压力阶差（AVP）。术后1周复查超声心动图,并于术后3个月至3年随访观察。结果15例患者术后一周症状改善,AVP由平均（112±66）mmHg显著降至（28±17）mmHg（P〈0．05）。平均随访1．6±1．3年期间,心衰症状改善明显,纽约心脏病学会（NYHA）心功能分级由3．3±0．5级降至1．7±0．9（P〈0．05）,与术前相比,LVDd有显著的降低、LVEF显著性增加（P〈0．05）,与术后1周比较也有改善;LVMI与术前和术后1周比较均有一定程度的降低,尽管尚无显著性差异（P〉0．05）;AVP在术后1周已有显著降低的基础上,在随访期间无明显变化（P〉0．05）。4例患者在随访期间死亡,其中因心源性死亡的3例患者均是合并严重冠脉三支病变曾同时行冠脉搭桥术。结论单纯重度主动脉瓣狭窄合并左室扩大、左室射血分数降低和左心衰的患者,外科主动脉瓣置换术是有效的治疗方法,术后跨主动瓣压差、左室内径及左室射血分数均有明显改善。合并严重冠状动脉狭窄或术前跨主动脉瓣压差较低的患者应进一步评价其手术风险及获益。     

25例主动脉瓣成形术后一年的超声心动图评价

目的 ：分析主动脉瓣反流（aortic insufficiency, AI）患者接受主动脉瓣成形术（aortic valvuloplasty,AVP）后1年的经胸超声心动图（心超）检查结果 ,评价AVP的效果。方法 ：25例接受AVP治疗的AI患者在术后1年时行心超检查,测量心腔大小、左心室收缩及舒张功能、AI分级、收缩期经主动脉瓣口流速及跨主动脉瓣压差等指标,并与术前检查结果比较,从心超角度评价AVP手术疗效。结果：心超检查显示,患者AVP术后1年的左室舒张末期内径[术前（54.4±4.6） mm比术后（50.0±4.9） mm,P=0.003]、左室舒张末期容积[术前（145.7±28.8） m L比术后（120.4±27.8） mL,P<0.001]、左室收缩末期内径[术前34.0(31.0,38.0) mm比术后31.0(29.5,34.0) mm,P<0.001]、左室收缩末期容积[术前47.0(37.5,63.0) mL比术后37.0(32.5,48.5) mL,P=0.005]、左室每搏输出量[术前（92.6±18.4） mL比术后（78.4±17.8） m ...     

超声与磁共振成像评估主动脉瓣狭窄患者左室重构的应用价值分析

目的:探讨超声与磁共振成像(MRI)在评估主动脉瓣狭窄患者左室重构中的应用价值。方法:选取2020年5月—2023年4月青岛阜外心血管病医院就诊的71例行外科主动脉瓣置换术的患者,所有患者均接受超声心动图和心脏MRI检查。以临床最终确诊检查结果为金标准,评价超声心动图、心脏MRI对主动脉瓣狭窄患者左室重构的诊断效能,比较左心室构型异常组与左心室构型正常组患者的超声心动图参数。结果:71例主动脉瓣狭窄患者临床最终确诊左心室重构45例,未出现左心室重构26例。超声心动图诊断主动脉瓣狭窄患者左室重构的灵敏度为95.56%(43/45)、特异度为73.08%(19/26)、准确率为87.32%(62/71)均高于心脏MRI诊断主动脉瓣狭窄患者左室重构的91.11%(41/45)、61.54%(16/26)、80.28%(57/71),但差异无统计学意义(P>0.05);左心室构型异常组左室舒张末期内径(LVEDD)、左心室收缩末期内径(LVESD)、二尖瓣口舒张早期和晚期峰值流速比值(E/A)高于左心室构型正常组,左室射血分数(LVEF)低于左心室构型正常组,差异有统计学意义(P<...     

经导管主动脉瓣置换术后新发完全性左束支传导阻滞的影响因素及其对心脏重构逆转的影响

目的 分析主动脉瓣狭窄(AS)患者经导管主动脉瓣置换术(TAVR)后新发完全性左束支传导阻滞(CLBBB)的影响因素及CLBBB对术后心脏重构逆转的影响。方法 收集55例接受TAVR治疗的AS患者，其中16例术后新发CLBBB并持续至少1个月(CLBBB组),31例术后未出现新发CLBBB、8例术后1天内出现新发CLBBB但于1个月内CLBBB消失(NO-CLBBB组);对比2组术前与术后1天血红蛋白(Hb)、N-末端脑利钠肽前体(NT-proBNP)、肌酐(Cr)、肌酸激酶同工酶(CK-MB)及肌钙蛋白(cTn),以及术前与术后1个月超声心动图相关参数及NYHA心功能分级。结果 2组术后1天血清cTn均较术前升高(P均<0.05),但组间差异无统计学意义(P>0.05)。术前CLBBB组室间隔舒张末期厚度(IVSD)、主动脉瓣峰值跨瓣压差(PPG)、主动脉瓣平均跨瓣压差(MPG)均大于NO-CLBBB组(P均<0.05)。术后1个月，NO-CLBBB组左心室质量(LVM)、IVSD、左心室后壁舒张末期厚度(LVPWD)、肺动脉收缩压(PASP)、PPG、MPG均较术...     

超声心动图评估主动脉瓣人工瓣膜置换术后室间隔运动异常情况

目的探讨超声心动图在评估主动脉瓣人工瓣膜置换术后室间隔运动异常中的作用。方法应用超声心动图对58例主动脉瓣重度狭窄患者和16例主动脉瓣重度关闭不全患者进行检查,测量术前及术后1周左室射血分数(LVEF)、室间隔运动幅度、室间隔增厚率(ΔT%)、左室每搏量(LVSV)及每分输出量(LVCO)变化情况。结果主动脉瓣狭窄和主动脉瓣关闭不全患者术后LVSV和LVCO均升高,室间隔运动幅度均减低,与术前比较差异均有统计学意义(均P0.05);LVEF和ΔT%与术前比较差异均无统计学意义。结论超声心动图能较好地评价主动脉瓣人工瓣膜置换术后室间隔运动异常及其对左室整体收缩功能的影响。     

Balloon aortic valvuloplasty as a treatment option in the era of transcatheter aortic valve implantation

Aortic valve stenosis is the commonest encountered valvular pathology and a frequent cause of morbidity and mortality in cases of severe stenosis. Definitive treatment has traditionally been offered in the form of surgical aortic valve replacement in patients with an acceptable surgical risk and more recently with the less invasive transcatheter aortic valve implantation (TAVI) in those where surgery is not a viable option. Prior to the introduction of TAVI, inoperable patients were treated medically and where appropriate with balloon aortic valvuloplasty, a procedure which although effective only provided short-term relief and was associated with high complication rates especially during its infancy. Here we discuss whether balloon aortic valvuloplasty continues to have a role in contemporary clinical practice in an era where significant advances have been achieved in the fields of surgical aortic valve replacement, TAVI and postoperative care.     

Percutaneous aortic valve replacement: A novel design of the delivery and deployment system

The frontier of percutaneous aortic valve replacement is challenged by hemodynamic and anatomic obstacles in the precise positioning of the device. With vital structures such as the mitral valve apparatus and the coronary ostia on either side, the margin of error is only within a few millimeters in the placement of the percutaneous aortic valve. An optimal system of delivery and deployment of this device has yet to be made commercially available. A novel design of a system of delivery and deployment of currently investigational aortic valved‐stent is presented. In the proposed procedural and equipment strategy, the local hemodynamic and anatomic conditions are controlled to allow for precise placement of the device, and overall improvement of the patient stability and safety can be made possible. Continued efforts in innovative designs in this area are encouraged such that the percutaneous valvular intervention can become mainstay as it has in the arena of percutaneous coronary intervention.     

Aortic root replacement surgery: indications,techniques and outcomes

Aortic root pathology is a common cause of aortic insufficiency. Aortic root aneurysm and aortic dissection, if left untreated, carry significant risk of mortality and morbidity. Surgical treatment involves replacement of the aortic valve, sinuses and ascending aorta. A number of prosthetic options have been developed including composite valve–synthetic graft, xenograft, homograft and pulmonary autograft. The current review describes the two main indications for aortic root replacement surgery, aortic dissection and root aneurysm, and discusses the various operative strategies and outcomes.     

全主动脉弓置换加支架象鼻手术治疗DeBakeyⅠ型主动脉夹层瘤的护理

目的探讨行升主动脉、全弓置换加支架象鼻手术治疗DebakeyⅠ型主动脉夹层瘤的护理重点。方法 7例Debakey I型主动脉夹层瘤患者行升主动脉、全弓置换加支架象鼻手术治疗,围术期接受精心的治疗和护理,分析其临床资料。结果全部手术都成功,术后恢复顺利,无护理相关并发症出现。结论止痛、控制血压、有效的心理护理和预防并发症的发生是促进患者度过急性危险期的关键。     

Hybrid aortic arch and frozen elephant trunk reconstruction: bridging the gap between conventional and total endovascular arch repair

Introduction: Novel endovascular techniques hope to offer patients aortic arch repair with reduced morbidity compared to conventional arch surgery; however, current endovascular strategies remain challenged by the proximal seal zone, higher stroke rates, long-term durability and select anatomy. Hybrid arch repair offers patients a less invasive alternative that can treat more distal aorta than conventional arch repair yet still be performed via standard sternotomy.

Areas covered: This review will discuss the current evidence and future development of hybrid aortic arch and frozen elephant trunk reconstruction. Several approaches to hybrid arch repair are summarized, including the off-label use of thoracic endovascular stent-grafts and commercially manufactured hybrid grafts. Technical considerations and clinical outcomes with each approach will be addressed along with advantages and disadvantages.

Expert commentary: Hybrid arch repair will undergo continued refinement as our ability to provide a less-invasive alternative to conventional open arch repair grows. Evolution to allow for improved head vessel branch sizing, improved frozen elephant trunk deployment accuracy, monitoring to prevent paraplegia and utilization of intraoperative image guidance in hybrid operating rooms is necessary. The potential exists for hybrid approaches to arch pathology to completely supplant conventional surgery, while avoiding the potential deleterious complications of total endovascular repair.     

Quadricuspid aortic valve associated with aortic stenosis and regurgitation: report of a case and a review of the literature

Quadricuspid aortic valve (QAV) is a rare congenital heart valve disease, and more than half of QAV patients have severe aortic regurgitation (AR). We describe the case of a 66-year-old woman with QAV detected by transthoracic echocardiography during a medical checkup. Doppler echocardiographic examination showed mild aortic stenosis and mild AR. The patient has been under routine medical review without medication therapy. At follow-up echocardiographic examinations over a 4-year period, no significant changes in severity of aortic stenosis or AR were found. The clinical and functional characteristics of 192 cases of QAV were reviewed. The functional status of the QAV was known in 144 cases; of these, only 13 (9%) had both aortic stenosis and AR.     

A Case of Traumatic Aortic Transection Presenting With Hemorrhagic Shock

BackgroundAortic transection, or aortic rupture, is a rare diagnosis in trauma patients and carries a high mortality.Case ReportWe present the case of a 61-year-old man presenting to a Level I trauma center after being struck by a motor vehicle, found to have an aortic transection. He was initially hypotensive and resuscitated with blood products due to concern for hemorrhagic shock. Aortic injury was suspected after chest x-ray study demonstrated a widened mediastinum. Traumatic thoracic aortic transection with pseudoaneurysm was diagnosed on computed tomography of the aorta, and the patient was taken to the operating room for thoracic endovascular repair of the aorta.Why Should an Emergency Physician Be Aware of This?Diagnosis of aortic injury can be challenging, especially in trauma patients presenting with hypotension. Aortic injury must be suspected in patients presenting after a high-velocity mechanism injury. It is an uncommon cause of hemorrhagic shock in trauma patients and must be considered even if other traumatic injuries are identified, as it commonly occurs with other significant injuries. Although chest x-ray study can be useful, a negative chest x-ray study does not rule out aortic injury. Aortic injury is a time-sensitive diagnosis, and early identification is key to these patients surviving to receive definitive management in the operating room.     

Elastic properties of aorta in patients with primary hyperparathyroidism

In this study, we aimed to evaluate whether hyperpara thyroidism affects the elastic properties of aorta, calculated as aortic distensibility and aortic stiffness index. Eighteen patients with hyperparathyroidism were enrolled in the study. The control group consisted of 18 healthy subjects with similar baseline characteristics. All subjects underwent echocardiographic examination. Internal aortic root diameters were measured at 3 cm above the aortic valve by the use of two-dimensional guided M-mode transthoracic echocardiography, and arterial blood pressure was measured simultaneously from the brachial artery by sphygmomano metry. Two indexes of the aortic elastic properties were measured which are aortic distensibility and aortic stiffness index. The mean aortic stiffness index of hyperparathyroidic patients was higher (3.04 +/- 1.26 vs. 2.36 +/- 1.09; p = 0.048), and aortic distensibility was lower (15.62 +/- 5.84 vs. 22.64 +/- 14.54; p = 0.035) than the control group. The left ventricular (LV) mass index (242.44 +/- 46.3 vs. 212.8 +/- 43.97; p = 0.048), although it has failed to reach statistical significance, and LV wall stress (57.81 +/- 18.22 vs. 46.57 +/- 15.72; p = 0.08) of these patients was also higher than control group. Hyperparathyroidism increases aortic stiffness index and decreases aortic distensibility of primary hyper parathyroidic patients compared with normal population. The affected aortic elastic properties can be a factor in increased LV mass index and wall stress.     

多平面经食管超声心动图非对风湿性主动脉瓣病变的诊断价值

目的：比较多平面经食管超声心动图（MTEE）及经胸超声心动图（TTE）对非风湿性主动脉瓣病变的诊断价值,探讨对其病因及超声特点。方法：应用MTEE和TTE检查非风湿性主动脉瓣病变23例,部分病例手术资料对照,结果：MTEE显示该病变以及动脉瓣畸形、感染性心内膜炎较常见,其次为脱垂、退行性变;感染性心内膜炎所致的主动脉瓣关闭不全较严重,MTEE可清楚显示瓣叶数目、形态结构、穿孔、赘生物和钙化,准确判断瓣膜功能状况,而TTE仅能部分显示。结论：MTEE是诊断非风湿性主动脉瓣病变的最可靠的技术。