不同病因二尖瓣反流经导管缘对缘修复术后心脏逆重构分析和超声心动图应用经验

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中文摘要：目的:评估二尖瓣经导管缘对缘修复术(TEER)对功能性和退行性中重度二尖瓣反流患者术后6个月的瓣膜功能、心脏逆重构和心功能变化情况,并总结超声心动图应用经验.方法:回顾性分析 2022 年 7 月至 2023 年 2 月在云南省阜外心血管病医院接受二尖瓣TEER且完成 6 个月随访的 93 例中重度二尖瓣反流患者的超声心动图资料.根据病因将患者分为功能性二尖瓣反流(FMR)组和退行性二尖瓣反流(DMR)组.比较两组患者的瓣膜特征参数、术前和术后 6 个月的瓣膜功能、心腔容积和心功能指标.评估手术疗效,并总结超声心动图应用经验.结果:93 例患者中,FMR患者 71 例,DMR患者 22 例.与FMR组比,DMR组患者二尖瓣前叶长度较短,对合缘高度较低,对合深度较浅,瓣叶栓系比例较低,瓣环内外径较短,左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)较小,左心室射血分数(LVEF)较高、左心室整体纵向应变(GLS)绝对值较高(P均＜0.05).所有患者术后 6 个月二尖瓣反流分级、NYHA心功能分级较术前均显著改善(P均＜0.05),二尖瓣平均跨瓣压差较术前有所升高(P＜0.05).其中,FMR组术后LVEDV、LVESV、左心房容积指数(LAVI)较术前均显著降低(P均＜0.05),而DMR组术后左心室和左心房容积较术前差异均无统计学意义(P均＞0.05),观察期间两组患者LVEF和左心室GLS差异均无统计学意义(P均＞0.05).与FMR组相比,DMR组患者手术前后ΔLVEDV、ΔLVESV的绝对值均较小(P均＜0.05).结论:对于不同病因的中重度二尖瓣反流患者,二尖瓣TEER均可有效降低患者术后早期反流程度并改善心功能.FMR与DMR患者在术前瓣膜结构和术后心脏逆重构方面存在差异.在二尖瓣TEER的全流程中,超声心动图是重要的影像学评估及监测手段.

外文标题：Analysis of Cardiac Reverse Remodeling After Transcatheter Edge-to-edge Repair of Mitral Regurgitation due to Various Etiologies and Experience of Echocardiography Application

外文摘要：Objectives:To evaluate the valvular and cardiac function,cardiac reverse remodeling at 6-month after transcatheter edge-to-edge repair(TEER)for patients with functional and degenerative mitral valve regurgitation,and summarize the experience of echocardiography application.Methods:The clinical data of 93 patients with moderate to severe mitral regurgitation(MR)treated with TEER and completed 6-month follow-up in Yunnan Fuwai Cardiovascular Hospital from July 2022 to February 2023 were retrospectively analyzed.Patients were divided into functional mitral regurgitation(FMR)and degenerative mitral regurgitation(DMR)groups according to MR etiology.The valve characteristic parameters,as well as valvular function,chamber volume and cardiac functional parameters before and at 6 months after operation were compared.The key points of echocardiography application were summarized.Results:Among all patients,71 were FMR and 22 were DMR.There were differences in valve structure between the two groups.Mitral TEER were successfully accomplished and all patients completed 6-month follow-up.The key points of echocardiography application included:valve structure analysis,atrial septal puncture location,device delivery process monitoring and image optimization during clamping process.The mitral regurgitation grade and NYHA grade were significantly improved in all patients at 6 months after TEER(P<0.05),and the mean mitral valve pressure gradient was higher than that before operation(P<0.05).Left ventricular end-diastolic volume(LVEDV),left ventricular end-systolic volume(LVESV)and left atrial volume index in FMR group were significantly decreased(P<0.05),while left ventricular and left atrial volume in DMR group remained unchanged(P>0.05).There were no significant changes in left ventricular ejection fraction and left ventricular global strain in both groups during the observation period(P>0.05).The changes of LVEDV and LVESV before and after operation were more significant in FMR group than those in DMR group(P<0.05).Conclusions:Mitral TEER can reduce the degree of regurgitation and improve cardiac function in the early postoperative period for moderate and severe MR patients with different etiologies.There are differences in preoperative valve structure and postoperative cardiac reverse remodeling between FMR and DMR patients.Echocardiography is an important imaging technique for the evaluation and monitoring process before,during and post mitral TEER.

外文关键词：

echocardiographytranscatheter mitral valve edge-to-edge repairfunctional mitral regurgitationdegenerative mitral regurgitation

作者：

骆志玲、董晓丽、郭秋哲、王远征、李金、周运飞、余双兰、朱达、王首正、潘湘斌

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作者单位：

云南省阜外心血管病医院超声心动图影像科,昆明 650000

云南省阜外心血管病医院结构病区,昆明 650000

中国医学科学院北京协和医学院国家心血管病中心阜外医院结构性心脏病中心,北京 100037

关键词：

超声心动图二尖瓣经导管缘对缘修复术功能性二尖瓣反流退行性二尖瓣反流

基金：

国家自然科学基金地区科学基金云南省心血管系统疾病临床医学研究中心-重大心血管疾病诊治新技术研发项目云南高原心血管病流行特征、发病机制、诊疗新技术研究及应用示范项目云南省重大科技项目

项目编号：

31960133202102AA310002202103AC100004202302AA310045

出版年：

2024

DOI：

10.3969/j.issn.1000-3614.2024.03.004

中国循环杂志

中国医学科学院

中国循环杂志

CSTPCD北大核心

影响因子：2.803

ISSN：1000-3614

年,卷(期)：2024.39(3)

参考文献量22