经导管封堵外科术后心脏瓣周漏的初步经验Initial experiences of transcatheter closure of postsurgical cardiac paravalvular leak
潘文志,周达新,管丽华,葛均波
摘要(Abstract)：
目的评估经导管封堵外科术后心脏瓣周漏(PVL)的有效性及安全性。方法对本中心2009~2012年行经导管试封堵的PVL病例进行总结分析。结果共入选12例患者,包括7例主动脉瓣PVL及5例二尖瓣PVL。其中,9例男性和3例女性,平均年龄(60±10)岁;9例有1个PVL,3例有2个PVL;7例PVL(最大的)为新月形,3例为椭圆形,2例为类圆形。操作成功率为83.3%,临床成功率为66.7%,10例操作成功的患者中有8例病例纽约心脏学会(NYHA)分级提高1级以上。术后1个月,操作成功的患者PVL程度由术前平均3.1级降为1.3级(P=0.007),NYHA分级由平均2.9级降为1.8级(P=0.007),左室舒张末内径由56 mm降为52 mm(P=0.005),左房前后内径由69 mm降为60 mm(P=0.005),肺动脉收缩压由58 mmHg降为43 mmHg(P=0.01),NT-proBNP由1697 ng/L降至1066 ng/L(P=0.02),左室射血分数改变未达到统计学意义(P=0.25)。病例8术前有慢性肾功能不全,术后出现造影剂肾病,给予床旁血液透析1周,肾功能无明显改善,后出现心功能恶化,最后死亡。病例6出现溶血,及肾功能一过性损害(肌酐最高至136 mmol/L)。结论初步结果显示,经导管介入封堵外科术后PVL虽然有一定并发症发生风险,但成功率及效果可以接受,可以在有经验的中心开展。
关键词(KeyWords)： 瓣周漏;经导管封堵;成功率;并发症
基金项目(Foundation):
作者(Author): 潘文志,周达新,管丽华,葛均波
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