实时的左心室压力-体积循环在皮肤穿门修复期间使用MitraClip系统
Oliver Gaemperli1, Patric Biaggi, Remo Gugelmann
1Andreas Grüntzig Cardiac Catheterization Laboratories, University Hospital Zurich, Zurich, Switzerland. oliver.gaemperli@usz.ch
Circulation
|February 5, 2013
概括
使用MitraClip进行皮肤通透的中枢修复改善了血液动力学,减少了左心室预负荷,增强了心脏功能. 这种手术为患有不适合外科手术的严重额头骨吐症的患者提供了可行的替代方案.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏生理学 心脏生理学
背景情况:
- 严重的额叶吐 (MR) 是一个重大的临床挑战.
- 使用MitraClip设备进行皮肤穿透的 mitra门修复是手术修复的新兴替代方案.
- MitraClip对左心室 (LV) 负载条件和收缩性的影响需要进一步研究.
研究的目的:
- 评价使用MitraClip进行皮肤通透的关修复对左心室负荷条件和收缩性的影响.
- 为了评估MitraClip植入后的血液动力学变化和逆向LV重塑.
主要方法:
- 利用导电性导管技术记录了MitraClip手术的33名患者的压力-体积 (PV) 循环.
- 分析了末缩壁应力 (WSES),末缩壁应力 (WSED),心脏指数 (CI) 和肺毛细管压力 (PCWP) 的变化.
- 在随访时评估了总机械能量 (压力-体积面积) 和评估了临床结果 (NYHA类,LV体积).
主要成果:
- MitraClip修复增加了WSES和减少了WSED,表明LV负载发生了变化.
- 心脏指数显著增加,而平均PCWP下降,表明心脏输出量有所改善,拥堵减少.
- 没有显著的变化末压力-体积关系表明保留的收缩性.
- 随访显示,NYHA功能类显著改善,LV终端透支体积减少.
结论:
- 使用MitraClip进行皮肤穿中门修复有效地改善了严重MR患者的血液动力学概况.
- 该程序通过减少预负载,同时保持收缩性来诱导左心室逆向重塑.
- MitraClip疗法是非手术候选人的一个有价值的替代品,具有受损的LV功能和严重的MR.
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