通过导管三管干预后的右心室重塑和临床结果
Lyle Dershowitz1, Matthew K Lawlor2, Nadira Hamid2,3
1Division of Internal Medicine, New York Presbyterian Hospital-Columbia University Irving Medical Center, New York City, New York, USA.
概括
透导管三管替换 (TTVR) 实现了比修复 (TTVr) 更大的三管吐 (TR) 减少,导致逆右心室 (RV) 重塑. 干预后增加VR维度预测了不良的临床结果.
科学领域:
- 心脏病学 心脏病学
- 心血管外科心血管外科
- 医疗成像医学成像
背景情况:
- 剩余的三回 (TR) 可以对右心室 (RV) 功能产生负面影响,并在经过透气管三门干预后重塑.
- 了解TR降低和RV变化之间的关系对于优化患者治疗结果至关重要.
研究的目的:
- 描述残留TR对RV重塑和经过透气管三门修复 (TTVr) 或更换 (TTVR) 的临床结果的影响.
- 评估TR减少程度与RV结构和功能的变化之间的关联.
主要方法:
- 对接受TTVr或TTVR的61名患者的回顾性分析.
- 主要结局包括纵向三状环状平面缩外流 (TAPSE),部分面积变化 (FAC),肺动脉缩压 (PASP) 和RV维度 (RVd).
- 多变量模型评估了干预类型,TR减少,回声测量和临床结果 (死亡,HF住院,重新干预) 之间的关联.
主要成果:
- 与TTVr (n=36) 相比,TTVR (n=25) 导致TR降低更大.
- TTVR与TAPSE和PASP的下降有关,而TR的减少与VR尺寸 (RVd) 的减少有关.
- 随访时增加的RVd与复合的临床结果显著相关 (HR:9.27,p=0.03).
结论:
- 跨导管三门置换 (TTVR) 提供了优越的TR降低,促进RV反向改造.
- 在三管干预后持续或增加VR尺寸与较差的临床预后有关.
- 监测RV尺寸对于经过透气管三管程序后的风险分层和管理至关重要.
相关概念视频
01:25Aortic Regurgitation III: Medical Management
24
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
24
01:20Mitral Regurgitation I: Introduction
15
Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...
15
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
22
Mitral stenosis is a heart condition in which the mitral valve, which allows blood to flow from the left atrium to the left ventricle, becomes narrowed or stenotic. This narrowing hinders blood flow and leads to clinical symptoms requiring specific medical evaluations and management strategies. The following overview outlines the clinical symptoms, assessments, diagnostic findings, prevention methods, and treatments for mitral stenosis.Clinical ManifestationsDyspnea (shortness of breath): This...
22
01:25Mitral Regurgitation III: Medical Management
18
Mitral regurgitation (MR) is characterized by retrograde blood circulation from the left ventricle into the left atrium due to inadequate mitral valve closure. The severity of the condition, symptoms, and underlying cause determine treatment strategies.Monitoring and Pharmacological TreatmentPatients with mild to moderate MR typically do not need immediate intervention but regular monitoring to assess progression and guide treatment. Patients with mild MR should have an echocardiogram every 3-5...
18
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
22
Aortic valve regurgitation (AR) occurs when the aortic valve fails to close properly, allowing blood to flow backward from the aorta into the left ventricle. This backflow can result in two distinct clinical presentations: acute and chronic AR, each characterized by its own set of symptoms and physical findings.Acute Aortic RegurgitationAcute AR presents with a sudden onset of severe symptoms. Patients typically experience profound dyspnea (shortness of breath), chest pain, and signs of left...
22
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
16
Hypertrophic cardiomyopathy, or HCM, is an autosomal dominant genetic disorder characterized by asymmetric left ventricular hypertrophy without ventricular dilation. It is more common in men and is typically diagnosed in young, athletic adults.EtiologyHCM is primarily genetic and is caused by mutations in genes encoding sarcomeric proteins. Researchers have identified over 1400 mutations across at least 11 different genes. Among these, the most frequently occurring mutations are found in the...
16