关键词: 超声心动描记术, 经导管主动脉瓣置换术, 心尖途径, 主动脉瓣狭窄, 主动脉瓣反流

Abstract:

Objective To discuss the clinical application value of echocardiography in evaluating the early outcomes of transcatheter aortic valve replacement （TAVR） via the transapical approach， and to clarify the role of echocardiography in assessing the efficacy of the surgery. Methods The clinical data of 85 patients who received J-Valve prosthetic valves via the transapical TAVR were retrospectively analyzed. The patients were divided into AS group （simple aortic stenosis， n=20）， AR group （simple aortic regurgitation， n=37）， and AS&AR group （aortic stenosis with regurgitation， n=28）. Echocardiographic examination was performed on all the patients before operation， 1 week after operation， 3 months after operation， and 6 months after operation. The parameters including left ventricular end-diastolic volume （LVEDV）， left ventricular end-systolic volume （LVESV）， left ventricular ejection fraction （LVEF）， left ventricular fractional shortening （LVFS）， interventricular septal thickness （IVST）， left ventricular posterior wall thickness （LVPWT）， aortic valve peak flow velocity （AV V_max）， aortic valve mean transvalvular pressure gradient （AV PG_mean）， and paravalvular leak （PVL） width were measured to evaluate the cardiac function and the function of the prosthetic valve； the occurrence of postoperative complications of the patients in various groups was also analyzed. Results J-Valve prosthetic valves were successfully implanted in all 85 patients. There were no significant differences in age， gender， New York Heart Association （NYHA） heart function classification， history of hypertension， history of diabetes， history of hyperlipidemia， and history of coronary artery disease among various groups befor operation（P>0.05）， ensuring comparability. Compared with before operation， 1 week after operation， the AV V_max and AV PG_mean of the patients in AS group and AS&AR group were decreased （P<0.05）； there were no significant differences in various parameters of the patients in AR group （P>0.05）. Compared with before operation， 3 months after operation， the LVEF and LVFS of the patients in AS group were increased （P<0.05）， while the AV V_max and AV PG_mean were decreased （P<0.05）； the LVEDV and LVESV of the patients in AR group were decreased （P<0.05）， while the LVEF and LVFS were increased （P<0.05）； the LVEDV， LVESV， AV V_max， and AV PG_mean of the patients in AS&AR group were decreased （P<0.05）， while the LVEF and LVFS were increased （P<0.05）. Compared with before operation， LVEDV， LVESV， IVST， and LVPWT of the patients in all three groups 6 months after operation were decreased （P<0.05）， while LVEF and LVFS were increased （P<0.05）； the AV V_max and AV PG_mean of the patients in AS group and AS&AR group were decreased （P<0.05）； the AV PG_mean of the patients in AR group was decreased （P<0.05）. The postoperative complications included 3 cases of permanent pacemaker implantation （2 cases in AS group， 1 case in AR group）， 1 case of stroke （in AS group）， and 13 cases of PVL （4 cases in AS group， 5 cases in AR group， 4 cases in AS&AR group）. No deaths occurred during follow-up. Conclusion Echocardiography can accurately and quantitatively evaluate early changes in cardiac function and the functional state of prosthetic valves after transapical TAVR， providing objective evidence for evaluating surgical outcomes and postoperative complications.

Key words: Echocardiography, Transcatheter aortic valve replacement, Transapical approach, Aortic stenosis, Aortic regurgitation