经导管封堵心脏人工瓣膜置换术后周围漏

目的 探讨经导管堵闭器封堵外科瓣膜置换术后人工瓣膜周围漏(PVL)的可行性、有效性和安全性.方法 回顾性分析外科瓣膜置换术后诊断为PVL的5例患者,其中主动脉瓣机械瓣置换术后PVL 2例,二尖瓣生物瓣置换术后PVL 2例,主动脉瓣和二尖瓣机械瓣置换术后二尖瓣PVL1例.封堵前后检查超声心动图以评价疗效.结果 患者均采用国产封堵器进行堵闭.2例主动脉瓣PVL封堵术后无残余;3例二尖瓣PVL堵闭术后残存微量至少量反流.其中1例主动脉瓣PVL患者介入术中出现心脏穿孔、心包填塞,经穿刺引流后痊愈.3例二尖瓣PVL患者出现术后早期溶血,于术后1～3周恢复.与术前比较,3个月随访期间左心室舒张末期内径减小(52.2±6.8)mm比(61.1±7.2)mm,P＜0.05],肺动脉收缩压下降(40.0±5.4)mm Hg(1 mm Hg=0.133 kPa)比(57.0±3.6)mm Hg,P＜0.05],二尖瓣PVL患者左心房内径减小(49.0±4.3)mm比(56.0±6.3)mm,P＜0.05].结论 经导管封堵人工瓣置换术后PVL可行而且安全、有效,在具备适应证患者中可作为治疗选择.

Abstract：

Objective To evaluate the feasibility and efficacy of transcatheter closure of paravalvular leak (PVL) with Chinese-made occlder. Methods Five PVL patients were involved in this study, 2 out of the 5 patients underwent aortic mechanical valve replacements, 2 underwent mitral bioprosthetic valve replacements, and the remaining 1 underwent double mechanical valve replacement. Left ventricular end diastolic diameter, left atrial diameter and the systolic pulmonary artery pressure were assessed by echocardiography before and post the procedure. Results Complete occlusion without residual regurgitation was achieved in 2 patients with aortic PVL, for the 3 patients with mitral PVL, there was only tiny or mild mitral paraprosthetic leak remained post closure procedure. Cardiac perforation and pericardium tampenade occurred in 1 patient with aortic PVL during interventional closure and the patient recovered post emergent pericardiocentesis. Transient severe hemolysis and hemoglobinuria occurred in 3 patients with mitral PVL post closure procedure and they recovered after 1 to 3 weeks concervative therapy. During 3 months follow up, left ventricular end diastolic diameter ( 52. 2 ± 6. 8 ) mm vs. ( 61.1 ± 7.2 ) mm, P ＜0. 05], the systolic pulmonary artery pressure (40. 0 ±5.4) mm Hg( 1 mm Hg =0. 133 kPa) vs. (57. 0 ±3.6) mm Hg, P ＜ 0. 05] and left atrial diameter of mitral PVL patient ( 49. 0 ± 4. 3 ) mm vs. ( 56. 0 ±6. 3) mm, P ＜ 0. 05] were significantly reduced compared to before closure procedure. Conclusion Percutaneous or transapical left ventricular access closure of PVL is feasible, effective and relative safe in selected patients.

Transcatheter closure of paraprosthetic valve leaks post surgical valve replacements

Objective To evaluate the feasibility and efficacy of transcatheter closure of paravalvular leak (PVL) with Chinese-made occlder. Methods Five PVL patients were involved in this study, 2 out of the 5 patients underwent aortic mechanical valve replacements, 2 underwent mitral bioprosthetic valve replacements, and the remaining 1 underwent double mechanical valve replacement. Left ventricular end diastolic diameter, left atrial diameter and the systolic pulmonary artery pressure were assessed by echocardiography before and post the procedure. Results Complete occlusion without residual regurgitation was achieved in 2 patients with aortic PVL, for the 3 patients with mitral PVL, there was only tiny or mild mitral paraprosthetic leak remained post closure procedure. Cardiac perforation and pericardium tampenade occurred in 1 patient with aortic PVL during interventional closure and the patient recovered post emergent pericardiocentesis. Transient severe hemolysis and hemoglobinuria occurred in 3 patients with mitral PVL post closure procedure and they recovered after 1 to 3 weeks concervative therapy. During 3 months follow up, left ventricular end diastolic diameter ( 52. 2 ± 6. 8 ) mm vs. ( 61.1 ± 7.2 ) mm, P ＜0. 05], the systolic pulmonary artery pressure (40. 0 ±5.4) mm Hg( 1 mm Hg =0. 133 kPa) vs. (57. 0 ±3.6) mm Hg, P ＜ 0. 05] and left atrial diameter of mitral PVL patient ( 49. 0 ± 4. 3 ) mm vs. ( 56. 0 ±6. 3) mm, P ＜ 0. 05] were significantly reduced compared to before closure procedure. Conclusion Percutaneous or transapical left ventricular access closure of PVL is feasible, effective and relative safe in selected patients.