侯士强,陈莎莎,龙渝良,张源,张蕾,潘文志,周达新,葛均波

• 1:复旦大学附属中山医院心内科上海市心血管病研究所

摘要(Abstract)：

目的在二叶式主动脉瓣(BAV)行经导管主动脉瓣置换术(TAVR)中,分析术前多排螺旋CT(MDCT)预测的最佳导丝跨瓣角度、球囊预扩张角度和瓣膜释放角度规律,总结三种投照角度预测值的规律。方法回顾性分析2019年7月至2020年6月在复旦大学附属中山医院因严重症状性重度主动脉瓣狭窄(AS)而行TAVR的BAV患者31例。收集基线资料、术前评估和手术情况。使用MDCT预测TAVR最佳导丝跨瓣角度、球囊预扩张角度和瓣膜释放角度,按照横裂式BAV和纵裂式BAV分组,比较两组之间的差异和规律。结果最佳导丝跨瓣角度,横裂式BAV为右前斜(RAO)8?(18?,3?)、足位(CAU)25?(29?,17?),纵裂式BAV为左前斜(LAO)26?(21?,34?)、头位(CRA)13?(6?,22?),两者差异均有统计学意义(均P<0.001);最佳球囊预扩张角度(显示左冠状动脉开口),横裂式BAV为LAO 11?(9?,26?)、CRA 8?(1?,19?),纵裂式BAV为LAO 36?(30?,39?)、CRA 22?(14?,25?),两者差异均有统计学意义(均P<0.05);最佳球囊预扩张角度(显示右冠状动脉开口),横裂式BAV为LAO 48?(43?,60?)、CRA 26?(3?,29?),纵裂式BAV为LAO 48?(39?,70?)、CRA 25?(22?,33?),两者差异均无统计学意义(P=0.320、P=0.560);最佳瓣膜释放角度,横裂式BAV为RAO 12?(16?,4?)、CAU 25?(28?,19?),纵裂式BAV为LAO 21?(17?,26?)、CRA 3?(-2?,12?),两者差异均有统计学意义(均P<0.001)。结论术前MDCT可预测BAV行TAVR的最佳导丝跨瓣、球囊预扩张和瓣膜释放投照角度,这些角度与BAV为横裂式还是纵裂式相关,存在明显规律。

关键词(KeyWords)： 二叶式主动脉瓣;经导管主动脉瓣置换术;投照角度

Abstract:

Keywords:

基金项目(Foundation): 国家重点研发计划（2017YFC1104202-2）

作者(Author): 侯士强,陈莎莎,龙渝良,张源,张蕾,潘文志,周达新,葛均波

参考文献(References)：

• [1] Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the management of patients with valvular heart disease:A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. Circulation, 2017, 135(25):e1159-e1195.
• [2] Mack MJ, Brennan JM, Brindis R, et al. Outcomes following transcatheter aortic valve replacement in the United States. JAMA,2013, 310(19):2069-2077.
• [3] Jilaihawi H, Wu Y, Yang Y, et al. Morphological characteristics of severe aortic stenosis in China:imaging corelab observations from the fi rst Chinese transcatheter aortic valve trial. Catheter Cardiovasc Interv, 2015, 85(Suppl 1):752-761.
• [4] Francone M, Budde RPJ, Bremerich J, et al. CT and MR imaging prior to transcatheter aortic valve implantation:standardisation of scanning protocols, measurements and reporting-a consensus document by the European Society of Cardiovascular Radiology(ESCR). Eur Radiol, 2020, 30(5):2627-2650.
• [5]周达新，潘文志，吴永健，等.经导管主动脉瓣置换术中国专家共识（2020更新版）.中国介入心脏病学杂志，2020, 28(6):301-309.
• [6] Sievers HH, Schmidtke C. A classifi cation system for the bicuspid aortic valve from 304 surgical specimens. J Thorac Cardiovasc Surg,2007, 133(5):1226-1233.
• [7] Mylotte D, Lefevre T, S?ndergaard L, et al. Transcatheter aortic valve replacement in bicuspid aortic valve disease. J Am Coll Cardiol, 2014, 64(22):2330-2339.
• [8] Duran C, Masood I, Duran A, et al. Multidetector computed tomography(MDCT)angiography in the pre-procedural assessment of patients undergoing transcatheter aortic valve replacement.Eurasian J Med, 2020, 52(1):86-93.
• [9] Binder RK, Webb JG, Willson AB, et al. The impact of integration of a multidetector computed tomography annulus area sizing algorithm on outcomes of transcatheter aortic valve replacement:a prospective, multicenter, controlled trial. J Am Coll Cardiol, 2013,62(5):431-438.
• [10] Ko?ka V, Theriault-Lauzier P, Xiong TY, et al. Optimal fl uoroscopic projections of coronary ostia and bifurcations defined by computed tomography coronary angiography. JACC Cardiovasc Interv, 2020,13(21):2560-2570.
• [11] Blanke P, Schoepf UJ, Leipsic JA. CT in transcatheter aortic valve replacement. Radiology, 2013, 269(3):650-669.
• [12] Hell MM, Biburger L, Marwan M, et al. Prediction of fl uoroscopic angulations for transcatheter aortic valve implantation by CT angiography:influence on procedural parameters. Eur Heart J Cardiovasc Imaging, 2017, 18(8):906-914.
• [13] Samim M, Stella PR, Agostoni P, et al. Automated 3D analysis of pre-procedural MDCT to predict annulus plane angulation and C-arm positioning:benefi t on procedural outcome in patients referred for TAVR. JACC Cardiovasc Imaging, 2013, 6(2):238-248.