金屏, 赖盛伟, 逯登辉, 刘洋, 徐臣年, 杨秀玲, 郭红, 熊红燕, 杨剑, 俞世强. 瓣周漏介入封堵治疗的安全性和有效性[J]. 心脏杂志, 2019, 30(1): 22-27. DOI: 10.12125/j.chj.201807047
    引用本文: 金屏, 赖盛伟, 逯登辉, 刘洋, 徐臣年, 杨秀玲, 郭红, 熊红燕, 杨剑, 俞世强. 瓣周漏介入封堵治疗的安全性和有效性[J]. 心脏杂志, 2019, 30(1): 22-27. DOI: 10.12125/j.chj.201807047
    Ping JIN, Sheng-wei LAI, Deng-hui LU, Yang LIU, Chen-nian XU, Xiu-ling YANG, Hong GUO, Hong-yan XIONG, Jian YANG, Shi-qiang YU. Safety and efficacy of transcatheter closure of paravalvular leakage: Clinical experience of 42 cases[J]. Chinese Heart Journal, 2019, 30(1): 22-27. DOI: 10.12125/j.chj.201807047
    Citation: Ping JIN, Sheng-wei LAI, Deng-hui LU, Yang LIU, Chen-nian XU, Xiu-ling YANG, Hong GUO, Hong-yan XIONG, Jian YANG, Shi-qiang YU. Safety and efficacy of transcatheter closure of paravalvular leakage: Clinical experience of 42 cases[J]. Chinese Heart Journal, 2019, 30(1): 22-27. DOI: 10.12125/j.chj.201807047

    瓣周漏介入封堵治疗的安全性和有效性

    Safety and efficacy of transcatheter closure of paravalvular leakage: Clinical experience of 42 cases

    • 摘要:
        目的   探讨瓣周漏(PVL)介入封堵治疗的安全性和有效性。
        方法   采用介入封堵术治疗瓣膜置换术后PVL 42例,既往行单纯二尖瓣瓣膜置换术15例,行单纯主动脉瓣瓣膜置换术13例,行主动脉瓣置换及二尖瓣联合置换术9例,行三尖瓣(功能二尖瓣)置换术2例,二尖瓣置换+冠状动脉旁路移植术3例,并发感染性心内膜炎10例,且术前感染性心内膜炎已得到有效控制。二尖瓣PVL 27例,其中机械瓣置换术后PVL 17例,生物瓣置换术后PVL 10例;主动脉PVL 15例,其中机械瓣置换术后PVL 8例,生物瓣置换术后PVL 7例。行介入封堵治疗PVL,术后随访1~36个月,主要观察患者介入封堵术前术后瓣周反流量、心功能及心室长、横径等的变化,封堵器植入后封堵器位置及对原有人工瓣膜是否存在影响以及并发症情况。
        结果   全组除2例患者因手术耐受性较差而未能完成手术,手术成功率95%。总体手术时间(122±30)min,其中数字减影血管造影(DSA)照射时间(20±9)min,住院时间(11±10)d。术后主要并发症包括血红蛋白尿2例(5%),急性肾功能衰竭行连续肾替代治疗治疗1例(2%),输血5例(12%)。心脏超声显示封堵器无移位,患者瓣周反流量减少至(0.5±0.7)ml,(P<0.05),且不影响人工瓣膜功能。
        结论   介入封堵方法治疗PVL安全有效,创伤小,恢复快,对于具备适应证的患者应可作为首选治疗方法。

       

      Abstract:
        AIM   To evaluate the safety and efficacy of transcatheter intervention of paravalvular leakage (PVL) after valve replacement.
        METHODS   Between May 2016 to May 2017, 42 patients of PVL after valve replacement underwent interventional therapy. There were 24 males and 18 females with mean age of (51.5±11.6) years. Previously, 15 patients underwent mitral valve replacement only, 13 patients underwent aortic valve replacement only, 9 patients had aortic valve replacement and mitral valve replacement, 2 patients underwent TVR, 3 patients underwent mitral valve replacement and coronary artery bypass grafting. 10 patients had a history of previous infective endocarditis. 25 patients used mechanical valve and the other 17 patients used biological valve. Transcatheter intervention was carried out in the catheterization laboratory or the hybrid operation room with the patient under local anesthesia first. Follow-up evaluation included peri-operational mortality, complications and postoperative residual shunt. The average follow-up time was 1 to 36 months.
        RESULTS   The success rate of transcatheter intervention was 95%, apart from 2 patients who were implanted with no occlusion. The main post-operative complications included 1case of acute renal failure (2%), 2 cases of hematuria (5%) and 5 cases of blood transfusion (12%), During the follow-up, there were no deaths. The regurgitation volume decreased to (0.54±0.74) ml (P<0.05). The remaining 40 patients did well, with improved heart function and no serious complications.
        CONCLUSION   Transcatheter intervention of PVL has the advantages of being a simpler and safer approach, less trauma, shorter time of hospitalization, faster post-operative recovery. For patients with appropriate indications, it should be the first choice of treatment.

       

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