邢超凡,潘欣,王小蕾,李艳杰,王承,马兰,何奔

• 1:上海市胸科医院心内科上海交通大学医学院附属胸科医院

摘要(Abstract)：

目的 评估经导管封堵外科二尖瓣置换术后瓣周漏（PVL）的有效性和安全性。方法 回顾性分析2010年3月至2020年12月在上海市胸科医院心内科经导管介入治疗二尖瓣置换术后PVL患者87例。患者术前经超声心动图筛查且有临床心功能下降和（或）溶血。记录操作路径、技术成功率、并发症和临床事件，完成平均1年随访。结果 87例患者平均年龄（55.7±25.8）岁，男46例（52.9%）。单纯二尖瓣置换术64例，二尖瓣和主动脉瓣联合置换术23例。10例（11.5%）为二尖瓣生物瓣置换术后，其余为机械金属瓣。5例（5.7%）经心尖直接穿刺路径，余经皮导管路径。介入技术成功率为64例（73.6%）。3例因介入治疗失败（并发严重溶血1例、封堵器影响人工瓣功能及左心室流入道各1例）转入心外科紧急手术，1例经心尖封堵PVL并发血胸手术开胸止血。封堵术相关性事件为术后溶血16例（18.4%），其中1例随访期间因溶血加重致急性肝肾功能衰竭死亡。多因素Logistic回归分析显示，术前存在溶血（OR 2.1,95%CI 1.3～3.9,P=0.021）、封堵器类型（OR 1.5,95%CI 1.1～2.5,P=0.032）、多枚封堵器置入（OR 0.7,95%CI 0.5～0.9,P=0.041）和金属机械二尖瓣（OR 0.6,95%CI 0.3～0.9,P=0.037）均为术后残余反流导致溶血的独立影响因素。1年平均生存率97.7%，介入治疗后较治疗前患者临床心功能（纽约心脏病协会心功能分级）改善[（1.4±0.4）级比（2.7±0.8）级，P=0.002]。随访期应用超声心动图评估PVL封堵术，提示术后患者左心室收缩末期内径[（31.7±6.9）mm比（36.3±10.1）mm,P=0.028]、左心室舒张末期内径[（51.3±8.4）mm比（54.7±9.5）mm,P=0.043]、左心房内径[58.4(43.7,89.2)mm比63.4(45.2,96.4)mm,P=0.035]均较术前明显缩小，肺动脉收缩压[（35.2±16.7）mmHg比（44.7±18.5）mmHg(1 mmHg=0.133 kPa),P=0.017]较术前下降，差异均有统计学意义。结论 经导管封堵二尖瓣PVL在外科中高危患者中可替代手术，改善临床症状，溶血是围术期及随访期主要并发症之一，值得重视。

关键词(KeyWords)： 瓣周漏;二尖瓣;介入治疗;随访

Abstract:

Keywords:

基金项目(Foundation): 上海市科委科研计划项目（17411970900）

作者(Author): 邢超凡,潘欣,王小蕾,李艳杰,王承,马兰,何奔

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