Clinical characteristics and safety of Lambl’s excrescence in intracardiac manipulation procedure
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摘要: 目的:探究Lambl’s赘生物(Lambl’s excrescence, LE)的临床特征及其与术中安全事件之间的关系。方法:2018年1月1日—2019年12月31日就诊于北京安贞医院行经胸或经食管超声心动图的547 095例患者中,30例被诊断为LE的患者纳入本研究,按照其后续治疗方案分为心内科组(16例)、心外科组(8例)及门诊组(6例)。分析各组患者的临床资料,探究LE的临床特征及其与术中安全事件之间的联系。结果:LE的发生率为5.5/10万人,患者平均年龄为(64.2±12.7)岁,男性约占56.7%。LE主要累及左心瓣膜,主动脉瓣约占80.0%,二尖瓣约占17.1%,其中主动脉右冠瓣比例最高约37.0%。约16.7%的LE可累及双瓣,以主动脉瓣合并二尖瓣为主。值得注意的是,LE合并主动脉瓣疾病或升主动脉/主动脉窦增宽的比例约为33.3%,尤其在心脏外科手术患者中达87.5%,而介入治疗的患者中比例为18.8%。在LE与心腔内操作安全性方面,所有接受介入治疗及心脏手术的患者中,均未发生术中安全事件。结论:LE在人群中发病率低,主要累及主动脉瓣及二尖瓣,且常合并主动脉瓣疾病。LE与心腔内操作术中栓塞事件不存在明显相关性。Abstract: Objective: To explore the clinical features of Lambl's excrescence(LE) and its relationship with intraoperative safety events.Methods: A total of 547 095 patients with transthoracic or transesophageal echocardiography were admitted to Beijing Anzhen Hospital from January 1, 2018, to December 31, 2019. Thirty of them were diagnosed with LE and were divided into cardiology group(n=16), cardiac surgery group(n=8), and outpatient group(n=6) according to their subsequent treatment plan. Clinical data of each group were analyzed to explore the clinical characteristics of LE and the relationship between LE and intraoperative safety events.Results: The incidence of LE was 5.5/100 000, the mean age of the patients was(64.2±12.7) years old, and the males accounted for 56.7%. LE mainly involved the left heart valve, the aortic valve accounted for about 80.0%, the mitral valve accounted for about 17.1%, and the proportion of the right aortic valve was the highest about 37.0%. About 16.7% of LE involved two valves, mainly aortic and mitral. Notably, LE was associated with a higher rate of aortic valve disease or ascending aortic/aortic sinus widening(33.3%), especially 87.5% in patients undergoing cardiac surgery and only 18.8% in patients undergoing interventional therapy. In terms of LE and safety of intracardiac procedures, no intraoperative safety event occurred in all patients receiving interventional therapy and cardiac surgery.Conclusion: LE has a low incidence in the population, mainly involving the aortic valve and mitral valve, and is often associated with aortic valve disease. There is no significant correlation between LE and intraoperative embolization events during intracardiac procedures.
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Key words:
- excrescence /
- embolism /
- interventional therapy
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