酒精隔膜切除用于左心室外流通道阻塞的预防,在过导管中枢置换程序之前:计算机断层扫描分析系列
Ayoub Belfekih1, Alaa Masri1, Aurélie Veugeois1
1Cardiology Department, Institut Mutualiste Montsouris, Paris, France.
概括
酒精隔膜切除有效降低左心室外流通道阻塞的风险,在接受过导管介质门置换的患者. 这种技术显著增加了新左心室外流通道的表面,改善了手术成功和患者的结果.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 心脏成像 - - 心脏成像
背景情况:
- 左心室外流通道阻塞 (LVOTO) 是跨导管中枢置换 (TMVR) 的重大限制,发生在7%-9%的病例中,导致25%的TMVR屏幕故障.
- 管理LVOTO风险对于成功的TMVR程序至关重要.
研究的目的:
- 评估酒精隔膜切除 (ASA) 在TMVR之前减轻LVOTO风险的有效性.
- 通过多阶段心脏计算机断层扫描 (CT) 评估ASA对新左心室外流管 (NeoLVOT) 维度的影响.
主要方法:
- 纳入了使用Sapiens 3假肢进行TMVR的患者,并确定了高LVOTO风险.
- 多阶段心脏CT被用于风险评估和监测.
- 酒精隔膜切除 (ASA) 是首要干预措施,以减少LVOTO风险.
主要成果:
- 9名患有高LVOTO风险的患者 (预测NeoLVOT表面<170毫米2) 在TMVR之前接受了ASA.
- 在ASACT后,预测的NeoLVOT表面 (174 mm2) 显著增加了95%.
- 最终的NeoLVOT表面比预测大 (215毫米2),没有显著的假肢泄漏或残留LVOTO. 幸存者报告说,症状缓解和肺动脉缩压 (PASP) 降低.
结论:
- 多阶段CT分析证实,ASA是一种有效的策略,用于在接受TMVR的患者中管理LVOTO风险.
- ASA显著增加了NeoLVOT的尺寸,促进了成功的TMVR和改善临床结果.
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