超声心动图在经心尖主动脉瓣人工瓣膜植入术治疗主动脉瓣狭窄患者中的应用价值

摘要

目的 探讨超声心动图在经心失主动脉瓣人工瓣膜植入术(TAAVI)治疗主动脉瓣狭窄患者中的应用价值.方法 选择2014年6月至2015年3月中国医学科学院阜外心血管病医院收治的接受TAAVI治疗的15例重度主动脉瓣狭窄患者.分别于术前、出院时、术后1个月、术后3～6个月采用超声心动图评估左心室舒张末内径、左心房内径及左心室射血分数、主动脉有效瓣口面积、平均跨瓣压差.采用单因素方差分析分别比较术前、出院时、术后1个月、术后3～6个月患者左心室舒张末期内径、左心房内径、左心室射血分数、主动脉瓣有效瓣口面积、平均跨瓣压差,进一步组间两两比较采用LSD-t检验.结果 入选15例患者术前超声心动图显示为重度主动脉瓣狭窄,平均有效瓣口面积(0.55±0.28) cm2,术前平均跨瓣压差为(58.93±14.96) mmHg(1 mmHg=0.133 kPa).1例患者术中超声示中量瓣周漏,重新放置瓣膜顺利.出院时、术后1个月、术后3～6个月患者左心室舒张末内径、左心房内径及左心室射血分数与术前比较差异均无统计学意义.除1例患者其他原因死亡外,术后超声随访结果示所有患者人工瓣膜位置均正常,7例患者探及瓣周1～2 mm反流.与术前比较,患者出院时及术后1个月、术后3～6个月主动脉瓣有效瓣口面积均增加,平均跨瓣压差均下降,且差异均有统计学意义(t=6.619、7.357、6.401,P均＜0.001;t=9.523、9.687、5.932,P均＜0.001).结论 术前经过超声心动图严格筛选,TAAVI治疗严重主动脉瓣狭窄患者效果良好.超声心动图在术中评估及术后随访中具有非常重要作用.%Objective To explore the value of echocardiography in patients with aortic stenosis who underwent transapical aortic valve implantation (TAAVI).Methods Fifteen high-risk patients with severe aortic stenosis were chosen in the present study,all of which received TAAVI in Fuwai Hospital Chinese Academy of Medical Sciences from June 2014 to March 2015.The left ventricular end-diastolic diameter (LVEDD),left atrial diameter (LAD),left ventricular ejection fraction (LVEF),effective orifice area (EOA),mean aortic pressure gradient (MPG),as well as artificial valve function of patients were measured at different time points (before operation,discharge,1 month and 3-6 months after operation) by echocardiography.The data were analyzed using one-way ANOVA analysis with SPSS software,and multiple comparisons were done using LSD student t test.Results The data from preoperative echocardiography indicated severe aortic stenosis in the 15 patients,with the average level of EOA as (0.55± 0.28) cm2 and MPG as (58.93± 14.96) mmHg (1 mmHg=0.133 kPa).Moderate paravalvular aortic regurgitation was observed in one patients,who was then received a second implantation.There was no significant difference between LVEDD,LAD,and LVEF when the patients were at discharge,1 month and 3-6 months after operation.The prosthetic valves were stable and conformed by echocardiography,while paravalvular leak regurgitation (1-2 mm) was observed in 7 patients.One patient died of other reasons.Compared with preoperative data,the EOA increased while MPG decreased when the patients were at discharge,1 month and 3-6 month after operation (t=6.619,7.357,6.401,all P ＜ 0.001;t=9.523,9.687,5.932,all P ＜ 0.001).Conclusion With careful patient screening and selection,TAAVI can be an effective treatment for high-risk severe aortic stenosis patients,in which echocardiography plays an important role during the surgery and follow up.