大動脈弁の生体置換:パンフレット不動性および弁血栓症
David R Holmes1, Michael J Mack2
1From Department of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); and Baylor Scott and White Health, Plano, TX (M.J.M.). holmes.david@mayo.edu.
Circulation
|May 3, 2017
まとめ
バイオプロステスの大動脈弁の不動性や弁血栓症は懸念されています. 4次元のCT画像は これらの状態の診断に 最も高い感度を示しています
科学分野:
- 心血管イメージング
- 義肢弁の合併症
- 介入心臓科
背景:
- トランスキャセターと手術による大動脈弁の生体置換の両方の合併症は知られています.
- これらの異常の発生率,臨床的意義,および最適な管理は不明である.
- 画像と処置技術の進歩は これらの合併症のより明確な理解を必要とします.
研究 の 目的:
- 大動脈の生体置換器におけるパンフレット不動性および弁血栓症に関する現在の理解をレビューする.
- 異なるイメージング方式の診断性能を評価する.
- 臨床的影響と治療戦略の進化について議論する.
主な方法:
- 大動脈弁のバイオプロテシスの合併症に関する現在の文献と臨床研究のレビュー.
- 様々なイメージング技術,特に4次元コンピュータトモグラフィー (4D CT) を用いて,フラフレット不動性および弁血栓の診断精度の分析.
- これらの弁の異常に関連する発生率,危険因子,および臨床結果に関する証拠の評価.
主要な成果:
- 4次元コンピュータトモグラフィー (4D CT) は,レフレット不動性および弁血栓の検出において,エコーカーディオグラフィーと比較して最も高い感度を示しています.
- 決定的な診断は4DCTの発見,抗凝固薬による解像度,およびトランスキャセターグラデントの上昇または病理学的確認によるものです.
- 現在進行中の研究では,トランスキャテータ大動脈弁置換 (TAVR) と外科大動脈弁置換 (SAVR) の症例発生率と臨床的重要性を調査しています.
結論:
- 4次元のCTは,大動脈のバイオプロテシスにおけるフラフレット不動性および弁血栓症の診断に最も敏感なイメージング方式です.
- これらの合併症の発生率,臨床的意義,および最適な管理に関する不確実性を解消するために,特に低リスク集団におけるTAVRの使用が拡大しているため,さらなる研究が不可欠です.
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