摘要
目的评估经导管封堵外科术后心脏瓣周漏（PVL）的有效性及安全性。方法对本中心2009～2012年行经导管试封堵的PVL病例进行总结分析。结果共入选12例患者，包括7例主动脉瓣PVL及5例二尖瓣PVL。其中，9例男性和3例女性，平均年龄（60±10）岁；9例有1个PVL，3例有2个PVL；7例PVL（最大的）为新月形，3例为椭圆形，2例为类圆形。操作成功率为83.3%，临床成功率为66.7%，10例操作成功的患者中有8例病例纽约心脏学会（NYHA）分级提高1级以上。术后1个月，操作成功的患者PVL程度由术前平均3.1级降为1.3级（P＝0.007），NYHA分级由平均2.9级降为1.8级（P＝0.007），左室舒张末内径由56 mm降为52 mm（P＝0.005），左房前后内径由69 mm降为60 mm（P＝0.005），肺动脉收缩压由58 mm Hg降为43 mm Hg（P＝0.01）， NT-proBNP由1697 ng/L降至1066 ng/L（P＝0.02），左室射血分数改变未达到统计学意义（P＝0.25）。病例8术前有慢性肾功能不全，术后出现造影剂肾病，给予床旁血液透析1周，肾功能无明显改善，后出现心功能恶化，最后死亡。病例6出现溶血，及肾功能一过性损害（肌酐最高至136 mmol/L）。结论初步结果显示，经导管介入封堵外科术后PVL虽然有一定并发症发生风险，但成功率及效果可以接受，可以在有经验的中心开展。
Objective To assess the efifcacy and safety of transcatheter closure of cardiac paravalvular leak (PVL). Methods We reported 12 cases of PVL patients undergoing transcatheter closure in our center from 2009 to 2012, and summarized the initial experiences. Results Twelve patients, 9 males and 3 females, of mean age 60±10 years, were enrolled, including 7 cases of aortic PVL and 5 mitral PVL. Nine cases had one PVL, and 3 cases had 2 PVLs. The (maximum) PVL in 7 cases was crescent, in 3 case was oval, and in the other 2 cases was nearly round. The success rate of procedure was 83.3%, and clinical success rate was 66.7%. One month after operation, the degree of PVL in the 10 cases successfully closed reduced from an average of 3.1 degree before operation to an average of 1.3 degree (P=0.007), NYHA functional class decreased from 2.9 to 1.8 class (P=0.007), left ventricular end-diastolic diameter declined from 56 mm to 52 mm (P=0.005), left atrium diameter decreased from 69 mm to 60 mm (P = 0.005) and systolic pulmonary artery pressure declined from 58 mm Hg to 43 mm Hg (P = 0.01), N-terminal pro-brain natriuretic peptide (NT-proBNP) decreased from 1697 ng/L to 1066 ng/L (P = 0.007). Left ventricular ejection fraction did not change statistically signiifcantly (P = 0.25, respectively). Case 8 had preoperative chronic renal insufifciency, and postoperative contrast-induced nephropathy occurred. Bedside hemodialysis was performed for one week, but renal function was not signiifcantly improved.. At last, the cardiac function was also deteriorated, and he died. Case 6 had hemolysis and acute kidney injury (creatinine up to 136 mmol/L). Conclusion Our preliminary experience showed that transcatheter closure of PVL was feasible with an acceptable success rate in experienced center, although there is a certain risk of complications.
出处
《中国医学前沿杂志（电子版）》
2013年第8期6-10,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
关键词
瓣周漏
经导管封堵
成功率
并发症
Paravalvular leak
Transcatheter closure
Success rate
Complications
