高海拔地区经导管主动脉瓣置换术的疗效观察
|
摘要
目的:评估经导管主动脉瓣置换术(TAVR)在高海拔地区治疗主动脉瓣疾病的效果。方法:入选2018-09-2019-09长期生活在高海拔地区的重度主动脉瓣狭窄或主动脉瓣关闭不全的7例患者,均进行经导管主动脉瓣置换术。术后观察主动脉瓣跨瓣压差及反流情况,门诊超声心动图随访,分析疗效和并发症经验。结果:7例患者中4例经股动脉途径,3例经心尖途径。术后左室舒张末期内径、左室射血分数、N末端脑钠肽前体(NT-proBNP)均较术前明显变化(P<0.05);4例主动脉狭窄患者术前跨瓣压差(92.45±15.96)mmHg(1mmHg=0.133kPa),术后即刻导管测跨瓣压差(49.25±1.5)mmHg(P<0.05);主动脉瓣关闭不全患者术后即刻变为无或微少量反流。术后发生Ⅲ度房室传导阻滞2例,发生肺部严重感染3例。结论:高海拔地区TAVR安全有效,但术后并发症不同于平原地区,需严格筛选患者和掌握适应证减少并发症发生。
Objective:To evaluate the efficacy of transcatheter aortic valve replacement(TAVR)in treating aortic valve disease at high altitude.Method:From September 2018 to September 20197 patients with severe aorta who lived in high altitude for a long time were selected for transcatheter aortic valve replacement.We observed the aortic valve cross-valve pressure difference and reflux conditions,outpatient echocardiography.Result:There were 4patients used the femoral artery pathway,and 3patients used the cardiac apex pathway.Left ventricular diastolic end-stage inner diameter,left ventricular ejection fraction,and NT-pfoBNP were significantly different than those before surgery(P<0.05).Preoperative cross-valve pressure difference(92.45±15.96)mmHg was observed in4 patients with aortic stenosis,and transvalve pressure difference(49.25±1.5)mmHg(P<0.05)was measured immediately after surgery.In patients with aortic valve insufficiency,there is no or a small amount of regurgitation immediately after surgery.There were 2cases ofⅢ degree atrial chamber block occurred after surgery and 3cases of severe lung infection occurred.Conclusion:TAVR is safe and effective at high altitudes,but postoperative complications are different from those in plain areas.Strict screening of patients and mastery of fitness can reduce complications.
Objective:To evaluate the efficacy of transcatheter aortic valve replacement(TAVR)in treating aortic valve disease at high altitude.Method:From September 2018 to September 20197 patients with severe aorta who lived in high altitude for a long time were selected for transcatheter aortic valve replacement.We observed the aortic valve cross-valve pressure difference and reflux conditions,outpatient echocardiography.Result:There were 4patients used the femoral artery pathway,and 3patients used the cardiac apex pathway.Left ventricular diastolic end-stage inner diameter,left ventricular ejection fraction,and NT-pfoBNP were significantly different than those before surgery(P<0.05).Preoperative cross-valve pressure difference(92.45±15.96)mmHg was observed in4 patients with aortic stenosis,and transvalve pressure difference(49.25±1.5)mmHg(P<0.05)was measured immediately after surgery.In patients with aortic valve insufficiency,there is no or a small amount of regurgitation immediately after surgery.There were 2cases ofⅢ degree atrial chamber block occurred after surgery and 3cases of severe lung infection occurred.Conclusion:TAVR is safe and effective at high altitudes,but postoperative complications are different from those in plain areas.Strict screening of patients and mastery of fitness can reduce complications.
引文
[1] Otto CM,Prendergast B.Aortic-valve stenosis-from patients at risk to severe valve obstruction[J].N Engl J Med,2014,371(8):744-756.
[2] Andersen HR,Knudsen LL,Hasenkam JM.Transluminal implantation of artificial heart valves.Description of new expandable aortic valve and initial results with implantation by catheter technique in closed chest pigs[J].Eur Heart J,1992,13(5):704-708.
[3] Cribier A,Eltchaninoff H,Bash A,et al.Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis:first human case description[J].Circulation,2002,106(24):3006-3008.
[4] Thonghong T,De Backer O,Sndergaard L.Comprehensive update on the new indications for transcatheter aortic valve replacement in the latest 2017European guidelines for the management of valvular heart disease[J].Open Heart,2018,5(1):e000753.
[5]苏文华,霍倩,赵燕,等.经导管主动脉瓣植入术治疗二叶式主动脉瓣重度狭窄有效性及安全性的Meta分析[J].临床心血管病杂志,2017,33(6):564-569.
[6] Medina-Lezama J,Narvaez-Guerra O,Herrera-Enriquez K,et al.Central arterial hemodynamics of hypertension at high altitude:the intervention trial[J].Circulation,2016,134(Suppl 1):A15955-A15955.
[7]李裕舒,朱峰.结构性心脏病的介入治疗进展[J].临床心血管病杂志,2017,33(10):928-930.
[8]刘坤,李裕舒,Emmanuel C,等.经导管主动脉瓣植入术研究进展[J].临床心血管病杂志,2016,32(10):967-968.
[9] Alec V,Ottavio A,Felicita A.Guidelines on the management of valvular heart disease(version 2012)[J].Eur Heart J,2012,30(5):2451-2496.
[10]Darren M,Thierry L,Yusuke W,et al.Transcatheter aortic valve replacement in bicuspid aortic valve disease[J].JACC,2014,64(22):2330-2339.
[11]潘文志,周达新,张晓春,等.经颈动脉途径行经导管主动脉瓣置换术治疗重度主动脉瓣狭窄的安全性和有效性[J].中华心血管病杂志,2018,46(3):198-202.
[12]Conte JV,Hermiller J Jr,Resar JR,et al.Complications after self-expanding transcatheter or surgical aortic valve replacement[J].Semin Thorac Cardiolvasc Surg,2017,29(3):321-330.
[2] Andersen HR,Knudsen LL,Hasenkam JM.Transluminal implantation of artificial heart valves.Description of new expandable aortic valve and initial results with implantation by catheter technique in closed chest pigs[J].Eur Heart J,1992,13(5):704-708.
[3] Cribier A,Eltchaninoff H,Bash A,et al.Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis:first human case description[J].Circulation,2002,106(24):3006-3008.
[4] Thonghong T,De Backer O,Sndergaard L.Comprehensive update on the new indications for transcatheter aortic valve replacement in the latest 2017European guidelines for the management of valvular heart disease[J].Open Heart,2018,5(1):e000753.
[5]苏文华,霍倩,赵燕,等.经导管主动脉瓣植入术治疗二叶式主动脉瓣重度狭窄有效性及安全性的Meta分析[J].临床心血管病杂志,2017,33(6):564-569.
[6] Medina-Lezama J,Narvaez-Guerra O,Herrera-Enriquez K,et al.Central arterial hemodynamics of hypertension at high altitude:the intervention trial[J].Circulation,2016,134(Suppl 1):A15955-A15955.
[7]李裕舒,朱峰.结构性心脏病的介入治疗进展[J].临床心血管病杂志,2017,33(10):928-930.
[8]刘坤,李裕舒,Emmanuel C,等.经导管主动脉瓣植入术研究进展[J].临床心血管病杂志,2016,32(10):967-968.
[9] Alec V,Ottavio A,Felicita A.Guidelines on the management of valvular heart disease(version 2012)[J].Eur Heart J,2012,30(5):2451-2496.
[10]Darren M,Thierry L,Yusuke W,et al.Transcatheter aortic valve replacement in bicuspid aortic valve disease[J].JACC,2014,64(22):2330-2339.
[11]潘文志,周达新,张晓春,等.经颈动脉途径行经导管主动脉瓣置换术治疗重度主动脉瓣狭窄的安全性和有效性[J].中华心血管病杂志,2018,46(3):198-202.
[12]Conte JV,Hermiller J Jr,Resar JR,et al.Complications after self-expanding transcatheter or surgical aortic valve replacement[J].Semin Thorac Cardiolvasc Surg,2017,29(3):321-330.