Effect of transcatheter aortic valve replacement on functional mitral regurgitation
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摘要: 目的 分析主动脉瓣重度狭窄合并功能性二尖瓣关闭不全的患者经导管主动脉瓣膜置换术(TAVR)后对二尖瓣关闭不全的影响。方法 回顾性统计分析从2017年9月—2021年12月我院收治的主动脉瓣重度狭窄合并功能性二尖瓣关闭不全接受TAVR的40例患者，在接受TAVR后6个月二尖瓣关闭不全、心脏超声数据的变化。结果 主动脉瓣跨瓣峰流速、主动脉跨瓣峰压差、左房横径、左房前后径、左室射血分数、二尖瓣关闭不全的情况在术后1周时与术前相比差异有统计学意义，这些差异在术后6个月时仍持续存在；左室舒张末期直径在术后6个月与术前相比差异有统计学意义；二尖瓣关闭不全的情况术后6个月时与术后1周比较差异有统计学意义。结论 主动脉瓣重度狭窄合并功能性二尖瓣关闭不全的患者在TAVR后，二尖瓣关闭不全的情况在围术期即会出现明显改善，且在6个月时会进一步改善。对于主动脉瓣重度狭窄合并功能性二尖瓣关闭不全的患者可以先进行TAVR手术解决主动脉瓣的重度狭窄，然后再定期评估二尖瓣关闭不全的情况，决定是否进一步处理二尖瓣病变。
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关键词:
- 经导管主动脉瓣置换术 /
- 主动脉瓣重度狭窄 /
- 二尖瓣关闭不全
Abstract: Objective This study sought to analyze the effect of transcatheter aortic valve replacement on functional mitral regurgitation in patients with severe aortic stenosis and mitral regurgitation.Methods A total of 40 patients with severe aortic stenosis and mitral regurgitation were enrolled who received transcatheter aortic valve replacement in our hospital from September 2017 to December 2021. The changes of mitral regurgitation and cardiac ultrasound data at 6 months after transcatheter aortic valve replacement were analyzed.Results There were statistically significant differences in aortic valve peak velocity, aortic valve peak gradient, left atrial transverse diameter, left atrium anteroposterior diameter, left ventricular ejection fraction and mitral regurgitation at 1 week after TAVR, and these differences still existed 6 months after TAVR. Compared with before TAVR, the difference of left ventricular end diastolic dimension was statistically significant at 6 months after TAVR. The mitral insufficiency was a statistically significant difference between 6 months after TAVR and 1 week after TAVR.Conclusion Functional mitral regurgitation in patients with severe aortic stenosis and mitral regurgitation was significantly improved perioperative and further improved at 6 months after TAVR. Patients with severe aortic stenosis combined with functional mitral regurgitation can undergo TAVR, and then periodically evaluate mitral regurgitation to determine whether to further manage mitral regurgitation. -
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表 1 患者超声心动图
Table 1. Echocardiography of the patients
X±S, M(P25, P75) 项目 术前 术后1周 术后6个月 LVEF/% 49.53±12.40 55.43±10.991) 58.50±7.381) LVEDD/mm 55.23(47.25，62.50) 53.23(51.50，58.50) 48.93(44.00，52.75)1) LATD/mm 46.63(41.25，50.50) 43.63(39.00，49.75)1) 39.50(34.00，43.75)1) LAAD/mm 41.95(39.00，45.00) 39.95(35.00，45.00)1) 38.43(33.25，42.00)1) AVPG/mmHg 88.88(69.50，103.00) 20.79(13.25，26.00)1) 18.63(11.50，22.75)1) AVPV/(cm/s) 459.68±76.47 221.50±49.791) 209.48±55.141) 与术前比较，1)P < 0.05。 
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表 2 二尖瓣关闭不全例数
Table 2. Number of mitral valve insufficiency
例(%) 二尖瓣关闭程度 术前 术后1周 术后6个月 0级 7(17.50) 9(22.50) 1级 13(3.25) 20(50.00) 2级 11(27.50) 8(20.00) 4(10.00) 3级 18(45.00) 7(7.50) 6(15.00) 4级 11(27.50) 5(12.50) 1(2.50)
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