论文部分内容阅读
目的总结三维计算机断层扫描(CT)影像学技术在经心尖主动脉瓣置换(TAVI)手术围手术期评估的技术要点。方法回顾性分析2014年4月至2015年6月于我院因主动脉瓣膜病变行TAVI手术的28例患者的临床资料,其中男12例、女16例,平均年龄(72.8±4.5)岁,所有患者均采用第二代人工生物介入瓣膜杂交手术。围手术期均采用三维CT影像技术对主动脉瓣膜区域及心脏大血管进行全面评估主动瓣膜形态、主动脉瓣环大小、双侧冠状动脉开口距离主动脉瓣环高度、升主动脉直径、主动脉窦部宽度、左心室长轴切面测量左心室主动脉夹角、三维全容积图像分析最佳造影投射角度。依据三维CT影像制定合理的手术策略包括瓣膜、预扩球囊大小选择,最佳术中造影投射角度以及心尖部入路。结果所有患者均成功行TAVI手术。logistic Euro-SCORE I评分26.2%±7.9%。CT测量平均瓣环径(24.6±1.8)mm,选择瓣膜平均直径(25.8±1.1)mm,平均预扩球囊直径(23.1±1.2)mm,瓣膜均呈三叶式;其中78.6%(22/28)患者重度钙化瓣膜,25.0%(7/28)患者不均匀钙化。依据术前三维全容积三维图像准确预测92.9%(26/28)患者术中造影最佳角度。患者术后平均跨瓣压差显著降低,与术前相比,差异有统计学意义[(54.1±15.3)mm Hg vs(13.1±8.5)mm Hg,P<0.05]。围手术期及随访期间未出现死亡病例、卒中、瓣膜移位、严重心血管不良事件等严重并发症。结论合理运用三维CT影像学技术是保证TAVI手术成功的关键,是帮助中国医师成功开展TAVI手术的重要手段。
Objective To summarize the technical points of perioperative evaluation of three-dimensional computed tomography (CT) imaging in patients undergoing apical aortic valve replacement (TAVI). Methods The clinical data of 28 patients with TAVI in our hospital from April 2014 to June 2015 were analyzed retrospectively. There were 12 males and 16 females with an average age of 72.8 ± 4.5 years. All patients underwent second-generation artificial bio-valve surgery. Perioperative three-dimensional CT imaging of the aortic valve area and cardiac aortic valve assessment of aortic valve morphology, the size of the aortic annulus, bilateral coronary artery opening from the height of the aortic annulus, the diameter of the ascending aorta, the aorta Sinus width, left ventricular long axis measurement of left ventricular aortic angle, three-dimensional volume image analysis of the best contrast projection angle. According to the three-dimensional CT imaging to develop a reasonable surgical strategy, including valves, pre-expanded balloon size selection, the best intraoperative angiography projection angle and apical approach. Results All patients underwent TAVI successfully. Logistic Euro-SCORE I score 26.2% ± 7.9%. The average annulus diameter of the valve was (24.6 ± 1.8) mm and the average diameter of the balloon was (25.8 ± 1.1) mm and the average diameter of the balloon was (23.1 ± 1.2) mm, respectively. All the valves showed a trilobal pattern. Among them, 78.6% 28) patients with severe calcified valve, 25.0% (7/28) patients with uneven calcification. The optimal angiography of the intraoperative angiography was accurately predicted by 92.9% (26/28) patients based on the preoperative three-dimensional full-volume three-dimensional images. The average postoperative transvalvular pressure difference was significantly lower than that before operation [(54.1 ± 15.3) mm Hg vs (13.1 ± 8.5) mm Hg, P <0.05). Perioperative and follow-up did not occur during the deaths, stroke, valvular displacement, severe cardiovascular complications such as serious complications. Conclusion The rational use of three-dimensional CT imaging is the key to successful operation of TAVI and is an important means to help Chinese physicians successfully carry out TAVI.