刘伟丽,李大成,刘松,屈占军,李燕超,唐国璋,江磊

• 1:青岛大学附属医院介入手术室
• 2:青岛大学附属医院PET-CT中心
• 3:青岛大学附属医院心血管内科
• 4:青岛大学附属医院心血管外科

摘要(Abstract)：

患者2年前行经导管主动脉瓣瓣中瓣置换术治疗重度主动脉瓣狭窄，术后并发中度瓣周漏（PVL），后进展为重度PVL、纽约心脏病协会（NYHA）心功能分级Ⅳ级、慢性心力衰竭。进行经导管介入封堵术成功封堵多漏口，PVL改善为轻-中度。半年后复查，NYHA心功能分级Ⅱ级、PVL改善为轻度，治疗效果满意。本例提示经导管主动脉瓣置换术（TAVR）术前影像评估应对PVL进行可能性分析，预计发生概率较大时，可针对性选择瓣膜以预防或改善PVL，并做好同期PVL封堵术准备；充分利用CT 3D重建、计算机辅助3D打印技术对多隧道PVL直观、立体和精准显示，对于合理选择封堵器和导丝，指导封堵策略，提高手术成功率具有重要价值。

关键词(KeyWords)： 多发性瓣周漏;介入封堵治疗;经导管主动脉瓣瓣中瓣置换术;计算机辅助3D打印

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘伟丽,李大成,刘松,屈占军,李燕超,唐国璋,江磊

参考文献(References)：

• [1] Van Belle E,Juthier F,Susen S,et al. Postprocedural aortic regurgitation in balloon-expandable and self-expandable transcatheter aortic valve replacement procedures:analysis of predictors and impact on long-term mortality:insights from the FRANCE2 Registry[J]. Circulation,2014,129(13):1415-1427. DOI:10.1161/CIRCULATIONAHA.113.002677.
• [2] Sinning JM,Hammerstingl C,Vasa-Nicotera M,et al. Aortic regurgitation index defi nes severity of peri-prosthetic regurgitation and predicts outcome in patients after transcatheter aortic valve implantation[J]. J Am Coll Cardiol,2012,59(13):1134-1141. DOI:10.1016/j.jacc.2011.11.048.
• [3] Waterbury TM,Reeder GS,Pislaru SV,et al. Techniques and outcomes of paravalvular leak repair after transcatheter aortic valve replacement[J].Catheter Cardiovasc Interv,2017,90(5):870-877. DOI:10.1002/ccd.27224.
• [4] St?hli BE,Nguyen-Kim TD,Gebhard C,et al. Prosthesisspecifi c predictors of paravalvular regurgitation after transcatheter aortic valve replacement:impact of calcification and sizing on balloon-expandable versus self-expandable transcatheter heart valves[J]. J Hear t Valve Dis,2015,24(1):10-21.
• [5] Kodali SK,Williams MR,Smith CR,et al. Two-year outcomes after transcatheter or surgical aortic-valve replacement[J].N Engl J Med,2012,366(18):1686-1695. DOI:10.1056/NEJMoa1200384.
• [6] Athappan G,Patvardhan E,Tuzcu EM,et al. Incidence,predictors,and outcomes of aortic regurgitation after transcatheter aortic valve replacement:Meta-analysis and systematic review of literature[J]. J Am Coll Cardiol,2013,61(15):1585-1595. DOI:10.1016/j.jacc.2013.01.047.
• [7] Ussia GP,Barbanti M,Ramondo A,et al. The valve-in-valve technique for treatment of aortic bioprosthesis malposition an analysis of incidence and 1-year clinical outcomes from the italian CoreValve registry[J]. J Am Coll Cardiol,2011,57(9):1062-1068. DOI:10.1016/j.jacc.2010.11.019.
• [8]徐承义，苏晞，何亚峰.经导管介入封堵术治疗瓣周漏的现状[J].中国介入心脏病学杂志，2020,28(10):579-584.DOI:10.3969/j.issn.1004-8812.2020.10.008.
• [9]张蔚菁，潘文志，管丽华，等.经导管主动脉瓣置换术中瓣周漏同期介入封堵1例[J].中国介入心脏病学杂志，2021,29(12):716-718. DOI:10.3969/j.issn.1004-8812.2021.12.013.
• [10] Otto CM,Nishimura RA,Bonow RO,et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease:executive summary:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J]. Circulation,2021,143(5):e35-e71. DOI:10.1161/CIR.0000000000000932.
• [11] Vahanian A,Beyersdorf F,Praz F,et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease[J].Eur Heart J,2022,43(7):561-632. DOI:10.1093/eurheartj/ehab395.
• [12] Nombela-Franco L,Rodés-Cabau J,DeLarochellière R,et al.Predictive factors,e ffi cacy,and safety of balloon post-dilation after transcatheter aortic valve implantation with a balloonexpandable valve[J]. JACC Cardiovasc Interv,2012,5(5):499-512. DOI:10.1016/j.jcin.2012.02.010.
• [13] Gafoor S,Franke J,Piayda K,et al. Paravalvular leak closure after transcatheter aortic valve replacement with a self-expanding prosthesis[J]. Catheter Cardiovasc Interv,2014,84(1):147-154. DOI:10.1002/ccd.25176.
• [14] Smolka G,Pysz P,Jasiński M,et al. Multiplug paravalvular leak closure using Amplatzer Vascular PlugsⅢ：a prospective registry[J].Catheter Cardiovasc Interv,2016,87(3):478-487. DOI:10.1002/ccd.25992.
• [15] Détaint D,Lepage L,Himbert D,et al. Determinants of significant paravalvular regurgitation after transcatheter aortic valve:implantation impact of device and annulus discongruence[J].JACC Cardiovasc Interv,2009,2(9):821-827. DOI:10.1016/j.jcin.2009.07.003.
• [16] Mao Y,Ma Y,Liu Y,et al. Transcatheter closure of a paravalvular leak after transcatheter aortic valve replacement with 3-dimensional printing guidance:a case report[J].J E n d o v a s c T h e r, 2 0 2 3, 3 0(3):4 7 1-4 7 6. D O I:10.1177/15266028221120770.
• [17] Mc Elhinney DB. Will there ever be a Food and Drug Administration-approved device for transcatheter paravalvular leak closure?[J]. Circ Cardiovasc Interv,2014,7(1):2-5. DOI:10.1161/CIRCINTERVENTIONS.114.001286.
• [18]苏文，黄亿源，台适，等.经导管主动脉瓣置换术后瓣周漏尝试封堵一例[J].华西医学，2020,35(4):484-488. DOI:10.7507/1002-0179.202002386.
• [19] Lesser JR,Han BK,Newell M,et al. Use of cardiac C T angiography to assist in the diagnosis and treatment of aortic prosthetic paravalvular leak:a practical guide[J]. J Cardiovasc Comput Tomogr,2015,9(3):159-164. DOI:10.1016/j.jcct.2014.11.001.