摘要
目的:评估经皮主动脉瓣球囊扩张术(PBAV)在合并左心功能不全的钙化型重度主动脉瓣狭窄患者中的应用。方法:2014-12至2017-02我院共为15例重度主动脉瓣狭窄患者实施PBAV。患者的基线情况、超声参数、围手术期情况及后期随访均有详细的记录。结果:15例PBAV患者术前均合并严重心力衰竭[纽约心脏协会(NYHA)心功能Ⅲ级3例,Ⅳ级12例],其中2例术前合并心原性休克,1例术前曾发生心原性猝死。15例中6例患者计划为姑息性PBAV,9例为过渡性措施(1例为非心脏手术术前过渡)。15例PBAV均顺利完成,术中平均扩张(2.6±1.3)次,2例患者术后即刻出现完全性左束支传导阻滞,1例患者术中发生室性心动过速,1例患者术后3天发生缺血性脑卒中,未发生其他并发症。PBAV后即刻导管测得有创跨主动脉瓣峰值压差由术前(75.0±24.0)mm Hg降至(39.8±14.2)mm Hg(P<0.01)。出院前超声心动图评估跨主动脉瓣最大流速由术前(4.98±0.76)m/s降至(4.20±0.75)m/(sP<0.01),峰值跨瓣压差由(101.3±30.4)mm Hg降至(72.9±23.3)mm Hg(P<0.01),平均跨瓣压差由(62.4±19.0)mm Hg降至(44.9±15.1)mm Hg(P<0.01),术前与术后的左心室舒张末期内径(LVDD)及左心室射血分数(LVEF)差异无统计学意义(P>0.05)。N末端B型利钠肽原(NT-pro BNP)由术前(13 889±12 303)pg/ml降至术后(5 412±4 923)pg/ml(P<0.01)。术后平均随访(10.9±7.1)个月(3~27个月),NYHA心功能分级中位数由Ⅳ级提升至Ⅱ级。结论:对合并左心功能不全的主动脉瓣狭窄患者进行姑息性或过渡性PBAV的短期疗效可靠且安全,并发症发生率低,应是高危主动脉瓣狭窄患者的可选治疗方案。
Objective： To assess the clinical application of percutaneous balloon aortic valvuloplasty（PBAV） in patients with calcified severe aortic stenosis（AS） combining heart failure（HF）.Methods： A total of 15 relevant patients treated by PBAV in our hospital from 2014-12 to 2017-05 were studied. The baseline information, echocardiography parameters, peri-operative situation and follow-up condition were summarized.Results： All 15 AS patients were combined with severe HF including 3 with NYHA III and 12 with NYHA IV; 2 cases had cardiac shock. 6/15 patients received palliative PBAV for symptom relieving and 9 for bridging step（1 case pre-operative step for non-cardiogenic surgery）. PBAV was successful in all patients; the average operative dilation was（2.60±1.3） times; 2 patients suffered from complete left bundle block at immediate post-operation, 1 had ventricular tachycardia during the operation and 1 had ischemic stroke 3 days after operation, no other complications occurred. Catheter measured immediate post-operative peak transvalvular pressure gradient was decreased from（75.0±24.0） mmH g to（39.8±14.2） mmH g, P〈0.01. Echocardiography showed that before discharge, the max flow velocity was reduced from（4.98±0.76） m/s to（4.20±0.75） m/s, P〈0.01, max-PG reduced from（101.3±30.4） mmH g to（72.9.0±23.3） mmH g, P〈0.01, mean-PG reduced from（62.4±19.0） mmH g to（44.9±15.1） mmH g, P〈0.01; while left ventricular diastolic dimension and LVEF were similar at per-and post-operation, P〈0.05. NT-proB NP was decreased from（13 889±12 303） pg/ml to（5 412±4 923） pg/ml, P〈0.01. The average post-operative follow-up time was（3-27） months and the median NYHA grade improved from IV to II.Conclusion： Palliative and bridging PBAV was reliable and safe in severe AS-HF patients for short time, it had less complication and could be used as an optional treatment.
作者
王斌
苏茂龙
邱风
赖可可
温红梅
王建
王焱
WANG Bin;SU Mao-long;QIU Feng;LAI Ke-ke;WEN Hong-mei;WANG Jian;WANG Yan(Department of Cardiology, Xiamen University Affiliated Cardiovascular Hospital, Xiamen （361004）, Fujian, China)
出处
《中国循环杂志》
CSCD
北大核心
2018年第2期152-156,共5页
Chinese Circulation Journal
基金
厦门市科技惠民项目(3502Z20174010)
