主动脉瓣置换术后巨大左心室的恢复

目的     

超声心动图评价经心尖经导管主动脉瓣置换术治疗主动脉瓣单纯关闭不全的近中期疗效

目的:探讨经心尖经导管主动脉瓣置换术(TAVR)治疗主动脉瓣单纯关闭不全的近中期临床症状改善情况、左心室结构及功能等变化特点.方法:选取2018年1月至2019年6月在空军军医大学西京医院行经心尖途径TAVR治疗主动脉瓣单纯关闭不全的患者53例,随访1年,观察术后左心室各径线、主动脉生物瓣内和瓣周反流、二尖瓣反流程度等...     

经股动脉经导管主动脉瓣置换术治疗单纯主动脉瓣关闭不全

【摘要】 目的 探讨Venus-A支架瓣膜行经股动脉经导管主动脉瓣置换术治疗单纯主动脉瓣关闭不全患者的可行性。方法 回顾性调阅2018年12月至2019年12月在阜外医院接受经股动脉经导管主动脉瓣置换术的15例单纯主动脉瓣关闭不全患者的床资料。其中男性12例, 女性3例,年龄68—83岁,平均年龄(74.65±5.52)岁。患者术前均有左心功能不全症状,且术前心脏超声诊断均为单纯主动脉瓣重度返流。结果 患者行经股动脉经导管主动脉瓣置换术。所有病例成功植入Venus-A支架瓣膜。全组病例无死亡。出院前对患者进行临床评估和超声心动图检查。术中行瓣中瓣治疗3例,少量瓣周返流2例。其余病人均无明显瓣周返流,并且顺利出院。结论 经股动脉经导管主动脉瓣置换术治疗单纯主动脉瓣关闭不全患者是可行的,术后早期结果满意。     

主动脉瓣置换术后显著肥大左心室的逆转

目的 :探讨主动脉瓣置换术后显著肥大左心室的逆转和收缩功能的恢复趋势及其影响因素。方法 :分析 1991年 1月至 2 0 0 0年 12月间 3 2例左心室显著肥大患者施行主动脉瓣置换术后超声心动图随访资料。结果 :主动脉瓣置换术后左心室形态呈进行性缩小、心肌肥厚显著减轻。影响显著肥大左心室术后完全逆转的主要术前因素是左心室的收缩末内径≥ 6 0cm、舒张末容积指数≥ 2 10ml/m2 和重量指数≥ 15 0g/m2 (P <0 0 1)。术前射血分数≥ 0 40者术后射血分数和短轴内径缩短率的恢复显著优于术前射血分数 <0 40者 (P <0 0 5～ 0 0 1)。术后射血分数≥ 0 5 0或短轴内径缩短率≥ 2 5 %与术后恢复时间呈正相关 ,与术前左心室收缩末内径≥ 6 0cm呈负相关 (R2 =0 5 5 ,P <0 0 1)。　　结论 :在左心室的收缩末内径≥ 6 0cm或舒张末容积指数≥ 2 10ml/m2 、重量指数≥ 15 0 g/m2 和射血分数 <0 40前手术 ,有利于术后左心室逆转和左心室收缩功能恢复 ,术后 6个月～ 1年是恢复的关键期。     

经胸超声心动图判断左心室流出道梗阻对经皮主动脉瓣置换术的意义

目的：比经皮主动脉瓣置换术（TAVI）是高危主动脉瓣病变患者的有效治疗手段。本研究通过TAVI合并左心室流出道梗阻（LVOTO）的特殊病例,探讨经胸超声心动图（TTE）术前及术后诊断LVOTO对于TAVI的临床意义。方法：2018年7月至2020年6月间,于我院接受经股动脉TAVI手术的主动脉瓣狭窄患者226例。对接受TAVI患者在围术期进行左心室流出道（LVOT）形态及流速探查。结果：共6例患者出现LVOTO。2例患者TAVI手术的术前发现LVOTO,其室间隔基底段呈明显乙状室间隔,SAM征阳性,术后其LVOTO未见缓解。3例患者术前LVOT的流速正常,术后即刻出现LVOTO,其左心室室壁明显增厚,运动增强,左心室容积偏小,术后SAM阳性,经控制血压及心率治疗后,LVOTO缓解,流速恢复正常。1例患者术前LVOT流速正常,术后LVOT流速正常,左心室腔中部的中位LVOT出现流速明显增快,经治疗后缓解。结论：进行TAVI手术的患者多表现为左心室室壁增厚,左心室容积偏小,室间隔形态改变,易于出现LVOTO。TTE是检出LVOTO的有效手段,应于术前仔细探查,术后注意监测。     

经皮主动脉瓣置换术进展

主动脉瓣狭窄和关闭不全是常见病和多发病,外科开胸瓣膜置换手术创伤大,经皮主动脉瓣置换术逐渐成为该领域的新方法.借助于导管输送系统经股静脉穿房间隔顺行途径、股动脉逆行途径或非体外循环直接径路将设计的支架瓣膜置放于主动脉瓣环处而完成主动脉瓣置换.支架瓣膜的定位和植入为手术关键.自1992年Anderson首先提出以来,相关研究已从人工材料模型、动物实验研究过渡到小规模临床试验阶段.但仍面临手术操作复杂、并发症多等缺点,并且缺乏中长期大规模前瞻性研究.     

经皮主动脉瓣置换术进展

主动脉瓣狭窄和关闭不全是常见病和多发病,外科开胸瓣膜置换手术创伤大,经皮主动脉瓣置换术逐渐成为该领域的新方法。借助于导管输送系统经股静脉穿房间隔顺行途径、股动脉逆行途径或非体外循环直接径路将设计的支架瓣膜置放于主动脉瓣环处而完成主动脉瓣置换。支架瓣膜的定位和植入为手术关键。自1992年Anderson首先提出以来,相关研究已从人工材料模型、动物实验研究过渡到小规模临床试验阶段。但仍面临手术操作复杂、并发症多等缺点,并且缺乏中长期大规模前瞻性研究。     

成人主动脉瓣关闭不全行主动脉瓣成形术研究现状

主动脉瓣成形术(aortic valve repair,AVr)最早报道于1958年并用于室间隔缺损引起的主动脉瓣反流(aortic insufficiency,AI)[1];然而由于没有超声心动图对主动脉瓣空间结构和解剖清楚的认识,手术的早期临床效果有限.随着瓣膜置换的发展,人工瓣膜几乎替代了成形手术成为更佳的选择....     

经导管主动脉瓣置换术治疗白塞病合并重度主动脉瓣反流一例

目前,白塞病合并重度主动脉瓣反流的主要治疗方式为外科主动脉瓣置换术,但术后瓣周漏、瓣膜撕脱等严重并发症的发生率高。该文报道1例合并白塞病的重度主动脉瓣反流患者,接受经导管主动脉瓣置换术治疗后症状改善明显。随访2年,超声心动图提示人工瓣膜流速、跨瓣压差处于正常范围,无明显瓣周漏;心脏增强CT扫描未见瓣叶增厚、撕脱情况,短期临床效果满意。     

基于超声心动图的钙化性主动脉瓣疾病患病情况的回顾性研究

目的分析钙化性主动脉瓣疾病(CAVD)的患病情况。方法收集并回顾性分析行超声心动图检查年龄≥45岁患者的临床资料17 826例,男性9725例,女性8101例,其中45⁶4岁11 274例,6564岁11 274例,65⁷4岁4250例,7574岁4250例,75⁸4岁2052例,≥85岁250例。结果CAVD总患病率为12.8%,男性CAVD患病率明显高于女性(13.6%vs11.9%),CAVD发生年龄明显低于女性[(70±10)岁vs(71±10)岁,P=0.001]。CAVD患病率随着年龄增长明显增高,4584岁2052例,≥85岁250例。结果CAVD总患病率为12.8%,男性CAVD患病率明显高于女性(13.6%vs11.9%),CAVD发生年龄明显低于女性[(70±10)岁vs(71±10)岁,P=0.001]。CAVD患病率随着年龄增长明显增高,45⁶4岁,6564岁,65⁷4岁,7574岁,75⁸4岁,≥85岁4个年龄段患病率分别为5.3%、20.5%、32.9%和54.4%。CAVD患者最常受累及的瓣叶为无冠瓣,其次是右冠瓣+无冠瓣、右冠瓣和左冠瓣。CAVD患者常见的功能异常为主动脉瓣反流,且主动脉瓣反流较狭窄明显多见(77.1%vs 15.0%,P<0.01)。CAVD患者左心房扩大发生率明显高于左心室扩大(56.3%vs 22.2%),室间隔肥厚发生率明显高于左心室后壁(51.7%vs 24.2%,P<0.01)。结论 CAVD患病率随年龄增长显著增高。     

运动负荷超声评价主动脉瓣置换术后左心室收缩功能储备

目的:应用二维超声斑点追踪技术,评价主动脉瓣置换术后运动负荷试验中的左心室收缩功能储备。方法:21例因重度主动脉瓣狭窄进行瓣膜置换术的患者(左心室射血分数>50%)行运动负荷超声心动图检查,应用二维超声斑点追踪技术测量运动负荷试验中静息状态下及峰值负荷时的左心室收缩期长轴整体应变率(GLSRs),同时记录峰值负荷时的心肌摄氧量(pVO2)。结果与21例正常健康对照者进行比较。结果:静息状态下,病例组与对照组超声指标无明显差异。峰值负荷时,病例组pVO2低于正常组(P<0.05);GLSRs及二尖瓣环心肌收缩速度(Sm)均明显低于正常组(P<0.001)且与pVO2呈正相关(GLSRs:r=0.60,P=0.0007;Sm:r=0.65,P=0.002)。多重线性回归分析,病例组峰值负荷时的左心室收缩期应变率为pVO2的唯一影响因素。结论:主动脉瓣狭窄患者瓣膜置换术后,尽管静息状态下左心室功能正常,但运动负荷试验后,左心室收缩功能储备仍然低于正常。     

Reversal of left ventricular dilatation, hypertrophy, and dysfunction by valve replacement in aortic regurgitation

Although aortic valve replacement for aortic regurgitation relieves left ventricular volume overload, ventricular geometry does not consistently normalize. To assess the extent, determinants, and functional consequences of reversal of left ventricular dilatation and hypertrophy, 38 patients with severe aortic regurgitation were studied pre- and postoperatively by serial echocardiography and radionuclide cineangiography. Left ventricular end-diastolic dimension normalized in 58% of patients by 9 +/- 6 months postoperatively, at which time 50% of patients had normalized mass; cumulative normalization rose to 66% for end-diastolic dimension and 68% for left ventricular mass during further follow-up. All patients who had normalized end-diastolic dimension also had normal postoperative ejection fractions (mean 61 +/- 8%). In contrast, patients in whom the left ventricle remained dilated had a 42% prevalence of subnormal postoperative left ventricular ejection fraction. Preoperative left ventricular end-systolic dimension less than or equal to 55 mm identified 86% of patients in whom end-diastolic dimension normalized, whereas end-systolic dimension exceeded 55 mm in 81% of those with persistent dilatation; other proposed preoperative predictors of operative outcome correctly identified lower proportions (from 59% to 71%) of patients in whom left ventricular size did or did not normalize. In conclusion, aortic valve replacement resulted in normalized left ventricular chamber size and mass in two thirds of the patients selected for operation by current criteria; favorable geometric outcome is associated with persistence or recovery of normal left ventricular function.     

部分或全部保留瓣下结构的二尖瓣置换术对巨大左室几何学的影响

目的 动态观察二尖瓣置换术(Mitral valve replacement,MVR)后巨大左心室的几何学变化，对比3种不同术式对左心室形态学逆转的影响。方法 回顾性分析1992年1月至2002年1月间48例巨大左心室病人施行二尖瓣置换术后的超声心动图随访资料。结果 保留二尖瓣装置对巨大左心室形态的逆转有效，其中保留全部瓣下结构术后左窒缩小最显，部分保留其次，无保留术后早期缩小晚期再扩大。结论 对于二尖瓣关闭不全为主合并巨大左室。应尽量采用保留瓣下结构的术式，有利于术后晚期左心室形态的逆转。     

老年人主动脉瓣置换术后病死率分析

目的 对年龄≥70岁的主动脉瓣狭窄患者主动脉瓣置换术后的病死率进行分析.方法 回顾性分析246例年龄≥70岁、并接受主动脉瓣置换的主动脉瓣狭窄患者的临床资料.其中高血压144例(58.5%),心房颤动42例(17.1%),肥胖27例(11.0%),有心脏手术史18例(7.3%).结果 手术30 d内死亡29例,病死率为...     

老年人主动脉瓣置换术后病死率分析

Objective To analyze the mortality in people aged 70 years and over who had undergone aortic valve replacement (AVR) for aortic stenosis.Methods The clinical data of 246consecutive cases aged 70 years and over,who had received AVR,were retrospectively analyzed.The 144 cases (58.5 % ) had hypertension,42 cases ( 17.1 %) had atrial fibrillation,27 cases ( 11.0 % )were obeses,and 18 cases (7.3%) had undergone previous heart surgery.Results The 29 cases (11.8%) were dead within 30 days after operation.Among them,15 cases (8.8%) were with isolated AVR and the other 14 cases (18.7%) were with an associate procedure,the difference was significant (P ＜ 0.05).The rate of postoperative complication was 24 .4%.The commoncomplications were:48 cases (19.5%) with low cardiac output,24 cases (9.8%) with renal dysfunction,52 cases (21.1% ) with prolonged ventilatory support and 12 cases (4.9%) with sepsis.In the Poisson regression analysis,the main predictors of mortality were low cardiac output,renal failure,sepsis and associate procedure.The main predictors of morbidity were CBP time ＞ 120 min,atrial fibrillation and chronic obstructive pulmonary disease.Conclusions The balance between the benefits and risks of the surgery should be well evaluated before deciding to perform AVR.     

老年人主动脉瓣置换术后病死率分析

Objective To analyze the mortality in people aged 70 years and over who had undergone aortic valve replacement (AVR) for aortic stenosis.Methods The clinical data of 246consecutive cases aged 70 years and over,who had received AVR,were retrospectively analyzed.The 144 cases (58.5 % ) had hypertension,42 cases ( 17.1 %) had atrial fibrillation,27 cases ( 11.0 % )were obeses,and 18 cases (7.3%) had undergone previous heart surgery.Results The 29 cases (11.8%) were dead within 30 days after operation.Among them,15 cases (8.8%) were with isolated AVR and the other 14 cases (18.7%) were with an associate procedure,the difference was significant (P ＜ 0.05).The rate of postoperative complication was 24 .4%.The commoncomplications were:48 cases (19.5%) with low cardiac output,24 cases (9.8%) with renal dysfunction,52 cases (21.1% ) with prolonged ventilatory support and 12 cases (4.9%) with sepsis.In the Poisson regression analysis,the main predictors of mortality were low cardiac output,renal failure,sepsis and associate procedure.The main predictors of morbidity were CBP time ＞ 120 min,atrial fibrillation and chronic obstructive pulmonary disease.Conclusions The balance between the benefits and risks of the surgery should be well evaluated before deciding to perform AVR.     

Regression of left ventricular hypertrophy during 10 years after valve replacement for aortic stenosis is related to the preoperative risk profile.

BACKGROUND: Previous studies have suggested that regression of hypertrophy may be the underlying determinant of longevity and left ventricular function after valve replacement (AVR) for aortic stenosis (AS). The potential for hypertrophy regression could therefore be related to the preoperative risk profile. METHODS: Ninety-one consecutive patients with AS had a "project" Doppler-echo and radionuclide ventriculography in addition to the standard investigation programme prior to AVR with a disc valve (19-29mm, n=82), a caged ball valve (26-29mm, n=8), or a stented porcine valve (26mm, n=1); 49 (group A) were selected for a serial follow-up study while 42 served as controls (group B). Forty-two group A patients took part in a 1.5-year examination while 47 (26 group A, 21 group B) patients were studied at 10 years. RESULTS: Groups A and B were comparable as regards all pre- and intra-operative data including left ventricular mass index (LVMi). A previously developed preoperative prognostic index (PI) separated the patients into groups with low (n=23), intermediary (n=19) and high risk (n=49) with 10-year survivals of 87%, 58% and 43% (P<0.01). LVMi dropped from 202+/-58g/m(2)preoperatively to 152+/-45g/m(2)(P<0.0001) at 1.5 years, and 139+/-40g/m(2)(P<0.0001) at 10 years (three and six patients, respectively, with paravalvular leak or mitral regurgitation excluded). PI correlated with preoperative (r=0.51, P<0.001), 1.5-year (r=0.46, P<0.01), and 10-year LVMi (r=0.41, P<0.01). Also preoperative left ventricular ejection fraction correlated with the three LVMi measurements. Patients with systemic hypertension had higher LVMi at 1.5 years (193+/-42, n=6 vs 144+/-42, n=33, P<0.05) and 10 years (175+/-39, n=12 vs 124+/-31g/m(2), n=29, P<0.001). Patients with low, intermediary or high PI, excluding those with hypertension, had 1.5-year LVMi of 110+/-35 (n=8), 134+/-43 (n=9) and 164+/-33g/m(2)(n=16; P<0.01), respectively, and 10-year LVMi of 116+/-25 (n=17), 126+/-27 (n=6), and 146+/-41g/m(2)(n=6; P<0.05), respectively. There was no relation between LVMi at 1.5 or 10 years and peak or mean Doppler gradient, prosthetic valve size, or valve size index. CONCLUSIONS: Left ventricular hypertrophy regression for patients who survived up to 10 years after AVR for AS is dependent on the preoperative risk profile indicating that irreversible myocardial disease is the underlying factor. Systemic hypertension is an important factor in its own right.