77例拟行经导管主动脉瓣植入术患者主动脉根部影像学与临床合并症特点分析—单中心经验

发布时间：2018-06-01 03:02

本文选题：经导管主动脉瓣植入术 + 主动脉根部影像学　；参考：《北京协和医学院》2015年硕士论文

【摘要】：目的：总结我中心拟行经导管主动脉瓣植入术(TAVI)的外科高危主动脉瓣重度狭窄患者临床合并症及主动脉根部影像学特点。方法：入选我院2012-9至2015-1拟行TAVI的主动脉瓣重度狭窄患者77例,进行临床资料、合并症统计,行计算机断层摄影术(CT)扫描、经胸超声心动图采集主动脉根部解剖数据并分析。结果：77例患者平均年龄76(73～79)岁,男性45例占58%,其中52%合并高血压病,21%合并2型糖尿病,17%合并慢性肺病,19%合并脑血管病占,21%合并房扑房颤,5%合并慢性肾功能不全。经胸超声测量主动脉瓣平均跨瓣压差53(45～68)mmHg,左室射血分数(EF值)57(41～63)%。患者年龄及合并症发生率比美国单中心较低,但主动脉瓣跨瓣压差大,左室射血分数低。CT测量结果77例患者中三叶瓣45例占58%二瓣化32例占42%,二瓣化中带嵴13例,不带嵴19例。二瓣化发生率明显高于西方既往研究结果,二瓣化患者于三叶瓣相比左冠状动脉开口更高。经胸超声测量主动脉瓣瓣环结果与CT测量瓣环短经相近,与瓣环长径及平均经均存在统计学差异。结论：我中心拟行TAVI患者合并症发生率偏低,但瓣膜病变发展快,心功能差。其中二瓣化畸形所占比例高,与三叶瓣解剖特点有所不同。CT及经胸超声心动图对于主动脉瓣环测量结果存在明显差异。
[Abstract]:Objective: to summarize the clinical and radiographic features of surgical high-risk patients with severe aortic valve stenosis and aortic root in our center. Methods: 77 patients with severe aortic valve stenosis scheduled for TAVI from 2012-9 to 2015-1 in our hospital were selected for clinical data, complication statistics, computed tomography (CT) scan, and transthoracic echocardiography to collect and analyze the anatomical data of aortic root. Results the mean age of 77 cases was 76 ~ 73 ~ (79) years old, male 45 (58), of which 52% were complicated with hypertension, 21% with type 2 diabetes mellitus, 17% with chronic pulmonary disease, 19% with cerebrovascular disease, 5% with atrial flutter fibrillation and 5% with chronic renal insufficiency. The mean transvalvular pressure difference of the aortic valve was measured by transthoracic echocardiography. The mean pressure difference of the aortic valve was 5345 ~ 68mm / h, and the EF value of left ventricular ejection fraction (EF) was 5741 / 63. The age and complication rate of the patients were lower than that of the single center in the United States, but the pressure difference of the aortic valve was larger than that of the United States. The left ventricular ejection fraction (LVEF) was lower. The results of CT measurement showed that 45 cases of the trefoil valve had 58% bicuspid valve, 32 cases had the double valvular valve, 13 cases had crest and 19 cases had no crest. The incidence of double valvuloplasty was significantly higher than that of western previous studies, and the left coronary artery opening was higher in the patients with double valvular valve than in the trefoil valve. The results of aortic valve annulus measured by transthoracic ultrasound were similar to those measured by CT, and there were statistical differences between the results and the length and mean meridians of aortic annulus. Conclusion: the incidence of complications in patients with TAVI is low, but valvular disease develops quickly and cardiac function is poor. The results of aortic annulus measurement by CT and transthoracic echocardiography were different from those of trefoil valve.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R654.2

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