经导管主动脉瓣置换术治疗二叶式主动脉瓣狭窄的术中投照角度预测值分析

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。

Analysis of predictive intraoperative projection angles of transcatheter aortic valve replacement for bicuspid aortic stenosis

Objective To analyze the law of guidewire transvalvular,balloon predilation and valve release projection angles predicted by multiple detector computed tomography(MDCT)before transcatheter aortic valve replacement(TAVR)in the bicuspid aortic valve(BAV),summarizing the three predictive projection angles.Methods A retrospective analysis of 31 BAV patients who underwent TAVR for severe symptomatic AS in Zhongshan Hospital affiliated to Fudan University from July 2019 to June 2020 was retrospectively analyzed.The baseline data,preoperative evaluation and intraoperative situation were collected.MDCT was used to predict the best guidewire transvalvular angle,balloon predilation angle and valve release angle of TAVR,patients were grouped according to transverse and longitudinal BAV,and the differences and rules were compared.Results For the best guidewire transvalvular angle,the transverse BAV was RAO 8°(18°,3°)CAU 25°(29°,17°),and the longitudinal BAV was LAO 26°(21°,34°)CRA 13°(6°,22°),there was a statistical significant difference(all P<0.001);For the best balloon predilation angle(showing left coronary artery opening),transverse BAV was LAO 11°(9°,26°)CRA 8°(1°,19°),and the longitudinal BAV was LAO 36°(30°,39°)CRA 22°(14°,25°),there was a statistical significant difference(all P<0.05);For the best balloon predilation angle(showing the right coronary artery opening),the transverse BAV was LAO 48°(43°,60°)CRA 26°(3°,29°),longitudinal BAV was LAO 48°(39°,70°)CRA 25°(22°,33°),there was no statistical significant difference(P values were 0.320 and 0.560,respectively);For the best valve release angle,transverse BAV was RAO 12°(16°,4°)CAU 25°(28°,19°),and the longitudinal BAV was LAO 21°(17°,26°)CRA 3°(-2°,12°),there was a statistical significant difference(all P<0.001).Conclusions Preoperative MDCT can predict the best guidewire transvalvular,balloon predilation,and valve release projection angles for TAVR in BAV.These angles are related to whether BAV is transverse or longitudinal,and there are obvious rules.