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二叶式主动脉瓣(BAV)畸形是一种先天性瓣膜发育异常,在我国主动脉瓣狭窄患者中较常见,且该人群具有年轻、瓣膜钙化严重等特征。随着循证医学证据的积累和医疗器械的迭代更新,经导管主动脉瓣置换术(TAVR)的适应证不断扩大,未来将会有更多的BAV狭窄患者接受TAVR治疗,但BAV复杂的解剖结构对TAVR治疗提出巨大挑战。通过术前充分了解瓣膜解剖形态和制定手术策略,BAV狭窄患者在我国行TAVR治疗获得良好的临床效果,而在远期预后、新一代瓣膜的应用等方面仍需更多的研究。本文就TAVR治疗BAV狭窄的现有证据和研究进展进行综述。 相似文献
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目的在二叶式主动脉瓣(BAV)行经导管主动脉瓣置换术(TAVR)中,分析术前多排螺旋CT(MDCT)预测的最佳导丝跨瓣角度、球囊预扩张角度和瓣膜释放角度规律,总结三种投照角度预测值的规律。方法回顾性分析2019年7月至2020年6月在复旦大学附属中山医院因严重症状性重度主动脉瓣狭窄(AS)而行TAVR的BAV患者31例。收集基线资料、术前评估和手术情况。使用MDCT预测TAVR最佳导丝跨瓣角度、球囊预扩张角度和瓣膜释放角度,按照横裂式BAV和纵裂式BAV分组,比较两组之间的差异和规律。结果最佳导丝跨瓣角度,横裂式BAV为右前斜(RAO)8°(18°,3°)、足位(CAU)25°(29°,17°),纵裂式BAV为左前斜(LAO)26°(21°,34°)、头位(CRA)13°(6°,22°),两者差异均有统计学意义(均P<0.001);最佳球囊预扩张角度(显示左冠状动脉开口),横裂式BAV为LAO 11°(9°,26°)、CRA 8°(1°,19°),纵裂式BAV为LAO 36°(30°,39°)、CRA 22°(14°,25°),两者差异均有统计学意义(均P<0.05);最佳球囊预扩张角度(显示右冠状动脉开口),横裂式BAV为LAO 48°(43°,60°)、CRA 26°(3°,29°),纵裂式BAV为LAO 48°(39°,70°)、CRA 25°(22°,33°),两者差异均无统计学意义(P=0.320、P=0.560);最佳瓣膜释放角度,横裂式BAV为RAO 12°(16°,4°)、CAU 25°(28°,19°),纵裂式BAV为LAO 21°(17°,26°)、CRA 3°(-2°,12°),两者差异均有统计学意义(均P<0.001)。结论术前MDCT可预测BAV行TAVR的最佳导丝跨瓣、球囊预扩张和瓣膜释放投照角度,这些角度与BAV为横裂式还是纵裂式相关,存在明显规律。 相似文献
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二叶式主动脉瓣狭窄是经导管主动脉瓣置换术(transcatheter aortic valve replacement, TAVR) 的相对禁忌证,
其异常的解剖结构和病理特点增加了TAVR 的难度和风险,手术成功率低于三叶瓣患者。但随着手术策略的不断
优化和新一代人工瓣膜的应用,这类患者的TAVR 治疗效果得到改善。本文将对二叶式主动脉瓣狭窄的特点及其
TAVR 治疗策略的进展进行介绍。 相似文献
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目的 回顾性探究接受自膨胀式瓣膜(SEV)置入的经导管主动脉瓣置换术(TAVR)患者的基线临床特征、升主动脉根部解剖特点及术后新发传导障碍(NOCD)的相关因素。方法 回顾性研究自2014年12月至2022年11月于厦门大学附属心血管病医院接受TAVR手术的245例患者,根据纳排标准连续纳入167例术中置入SEV的患者,根据主动脉瓣形态分为三叶瓣组(TAV组,113例)和二叶瓣组(BAV组,54例),术后根据心电图特征将TAV组分为NOCD组(43例)和无NOCD组(70例);BAV组分为NOCD组(16例)和无NOCD组(38例)。收集患者术前心电图、升主动脉根部CT血管造影等临床资料。结果 在TAV组中:与NOCD组相比,无NOCD组的右-无冠瓣钙化定量更大(P=0.005),而主动脉成角则较小(P=0.002),多因素分析结果提示右-无冠瓣钙化定量每增加10 mm3,TAVR术后NOCD的发生风险降低2.6%(OR 0.974,P=0.039),主动脉成角每增加1°,术后NOCD的风险提升将近7.3%(OR1.073,P=0.003)。在BAV组中:术前PR... 相似文献
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经导管主动脉瓣置换术(transcatheter aortic valve replacement,TAVR)已经彻底改变了重度主动脉瓣狭窄的治疗方式。然而,单纯自体主动脉瓣返流(native aortic valve regurgitation,NAVR)一度被认为是TAVR的禁忌证,这是由于大部分患者主动脉瓣无钙化以及随之造成的锚定人工瓣膜困难。与主动脉瓣狭窄相比,TAVR的第一代瓣膜治疗NAVR,器械成功率较低,这是因为需要“瓣中瓣”比率以及术后中重度主动脉瓣返流复发几率较高。然而,随着新一代可回收、有裙边且有特殊固定机制瓣膜的研发与应用,此类患者的手术预后得到改善。本文对TAVR在单纯NAVR患者中的应用及两代瓣膜的临床预后进行了回顾和总结。 相似文献
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Use of aortic valve homografts for aortic valve replacement 总被引:1,自引:0,他引:1
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目的探讨治疗主动脉瓣关闭不全的外科手术方法及治疗效果。方法 2003年7月至2009年11月对188例主动脉瓣关闭不全患者行主动脉瓣成形术,并存术前、术中、术后利用超声对心脏结构及功能进行评价。结果采用佰仁思牛心包单瓣置换103例(54.8%)。出院时心功能(纽约心脏病协会分级)Ⅰ级168例,Ⅱ级20例。随访3个月至5年,无围手术期死亡。超声心动图显示,术前左心室舒张期末内径为(46.4±10.3)mm,术后减小为(39.3±9.2)mm(P<0.05);术前主动脉瓣收缩期压差为(11.4±5.0)mm Hg,术后为(9.3±2.2)mmHg(P>0.1),术前主动脉瓣收缩期流速为(1.5±0.2)m/s,术后为(1.5±0.5)m/s(P>0.1);术前主动脉瓣舒张期压差为(77.2±10.4)mm Hg,术后为(43.7±11.6)mm Hg(P<0.05),术前主动脉瓣舒张期流速为(4.7±1.6)m/s,术后为(3.6±0.8)m/s(P>0.1)。结论主动脉瓣成形术治疗主动脉瓣关闭不全具有良好的手术效果及安全性。 相似文献
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Subasit Acharji MD Arvind Agnihotri MD Joseph Carrozza MD 《Catheterization and cardiovascular interventions》2017,90(1):169-172
Unicuspid aortic valve (UAV) offers unique challenges to transcatheter aortic valve replacement (TAVR), due to asymmetric expansion and apposition of the prosthesis during implantation. Although TAVR in bicuspid is now a well described experience, TAVR in unicuspid valve has not yet been described. A challenging case is described with TAVR in UAV using a Edwards Sapiens prosthesis via transapical approach. © 2016 Wiley Periodicals, Inc. 相似文献
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Ashraf Hamdan MD Ran Kornowski MD FACC FESC 《Catheterization and cardiovascular interventions》2015,86(2):331-333
- In Preprocedural CT, patients with BAV have larger aortic annulus perimeters, and more calcified valves compared with TAV.
- In patients with BAV, self‐expandable valves were under‐expand and balloon‐expandable valves have a trend toward increased rates of postimplantation AR grade.
- Self‐expandable valves have higher postprocedural gradient in BAV compared with TAV.
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Graeter TP Fries R Aicher D Reul H Schmitz C Schäfers HJ 《The Journal of heart valve disease》2006,15(3):329-335
BACKGROUND AND AIM OF THE STUDY: Valve-preserving aortic replacement has become an accepted option for patients with aortic valve regurgitation and aortic dilatation. The relative role of root remodeling versus valve reimplantation inside a vascular graft has been discussed, albeit controversially. In the present study, an in-vitro model was used to investigate the aortic valve hemodynamics of root remodeling and valve reimplantation; roots with supracommissural aortic replacement served as controls. METHODS: Aortic roots with aortoventricular diameter 21 mm were obtained from pigs. Root remodeling was performed using a 22-mm graft (group I, n = 6), or valve reimplantation with a 24-mm graft (group II, n = 7). Control roots were treated by supracommissural aortic replacement (22-mm graft; group III, n = 7). Using an electrohydraulic, computer-controlled pulse duplicator, the valves were tested at flows of 2, 4, 5, 7, and 9 I/min at a heart rate of 70 /min and a mean arterial pressure of 100 mmHg. Parameters assessed included: mean pressure gradient, effective orifice area, valve closure and regurgitant volume, and energy loss due to ejection, valve closure and regurgitation. Data were compared using ANOVA. RESULTS: There were no differences between the three groups in terms of regurgitant volume, energy loss due to valve regurgitation, or valve closure. The aortic valve orifice area was largest and systolic gradient lowest in group I at all flow rates (p < 0.001). Ejection energy loss was lowest in group I at all flow rates (9 l/min: group I, 128 +/- 21 mJ; group II, 399 +/- 46 mJ; group III, 312 +/- 27 mJ; p < 0.001). Valve closure volumes were similar in groups I and III, but significantly lower in group II at all flow rates (p = 0.047). CONCLUSION: In this standardized experimental setting, root remodeling--but not valve reimplantation--resulted in physiologic hemodynamic performance of the aortic valve with regard to orifice area, pressure gradient, and systolic energy loss. 相似文献
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PURPOSE: Aortic valve preservation is a promising alternative to conventional composite replacement of aortic valve and ascending aorta. This approach may have a physiologic benefit compared with valve replacement similar to that seen in mitral valve reconstruction. We investigated aortic valve gradients at rest and during exercise in patients who had undergone valve-preserving aortic replacement and compared them with composite replacement of valve and aorta. METHODS: Four groups were studied: nine patients underwent composite valve replacement (group A: valve diameter, 23 to 27 mm), eight patients underwent remodeling of the aortic root (group B), and another nine patients had reimplantation of the aortic valve (group C). Healthy volunteers were studied as a control group (group D). Using continuous-wave Doppler echocardiography, all patients were examined on a bicycle ergometer for aortic valve gradients (0 to 75 W). RESULTS: There were no differences among the groups with respect to age, body surface, left ventricular end-diastolic diameter, fractional shortening, or left ventricular mass. Maximum resting gradients were significantly elevated in group A compared with groups B, C, and D (group A: 21.3 +/- 7.1 mm Hg; group B: 9.0 +/- 4.5 mm Hg; group C: 8.6 +/- 3.7 mm Hg; group D: 4.9 +/- 1.6 mm Hg; p < 0.05). At 75 W, group A exhibited significantly higher gradients than all other groups (group A: 31.3 +/- 7.5 mm Hg; group B: 13.9 +/- 6.6 mm Hg; group C: 12.8 +/- 3.5 mm Hg; group D: 9. 2 +/- 1.9 mm Hg; p < 0.05). There was no significant difference among the other groups. Both valve-preserving groups had only insignificantly higher gradients than the control group. CONCLUSION: Our data strongly support the suggestion that preserving the aortic valve restores nearly normal hemodynamic function of the aortic valve. Long-term observations will have to prove the clinical relevance of restoring physiologic aortic valve hemodynamics. 相似文献
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