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中华诊断学电子杂志 ›› 2014, Vol. 02 ›› Issue (01) : 1 -8. doi: 10.3877/cma.j.issn.2095-655X.2014.01.001

所属专题： 专题评论； 文献；

专题论述

超声心动图评估主动脉瓣置换术后早期并发症的临床应用
范立1, 王春生1, 程蕾蕾2,†()   
  1. 1. 200032　上海，复旦大学附属中山医院　上海市心血管病研究所心外科
    2. 上海市影像医学研究所心脏超声诊断室
  • 收稿日期:2013-11-30 出版日期:2014-02-26
  • 通信作者: 程蕾蕾
  • 基金资助:
    国家自然科学基金(81201095); 上海市影像医学研究所高级职称科研基金(HIMI-GJ-2013-005)

Echocardiographic detection of early complications after aortic valve replacement

Li Fan1, Chunsheng Wang1, Leilei Cheng2,†()   

  1. 1. Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China
  • Received:2013-11-30 Published:2014-02-26
  • Corresponding author: Leilei Cheng
  • About author:
    Corresponding Author: Cheng Leilei, Email:
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范立, 王春生, 程蕾蕾. 超声心动图评估主动脉瓣置换术后早期并发症的临床应用[J]. 中华诊断学电子杂志, 2014, 02(01): 1-8.

Li Fan, Chunsheng Wang, Leilei Cheng. Echocardiographic detection of early complications after aortic valve replacement[J]. Chinese Journal of Diagnostics(Electronic Edition), 2014, 02(01): 1-8.

主动脉瓣置换术(AVR)是目前治疗有症状的主动脉瓣病变的标准手术。AVR可明显改善主动脉瓣狭窄或反流患者的临床症状及血流动力学，手术效果好，远期生存率高。尽管经导管主动脉瓣置入术(TAVI)也被认可为治疗主动脉瓣病变的有效手段，但目前AVR仍然是最可靠的手术方式。超声心动图是主动脉瓣狭窄或反流最重要的诊断方法，是一种安全可靠的无创检测技术，在术前评估、明确手术指证、选择手术方式、判断预后等方面有重要的价值。AVR术后30d内发生的早期并发症影响患者预后，目前主要依靠超声心动图来检测和诊断。常规超声心动图的应用最为广泛，近年来超声心动图新技术如组织多普勒显像(TDI)、二维或三维斑点追踪显像、负荷超声心动图的应用也得到越来越多的临床医师重视。然而，超声心动图对AVR术后早期并发症的预测价值尚无充分的证据证明。笔者对AVR术后主要早期并发症及超声心动图检测方法进行系统回顾，以期为探究超声心动图指标预测术后早期并发症的价值提供参考。

关键词: 主动脉瓣置换术, 超声心动图, 早期并发症

Aortic valve replacement (AVR) is generally accepted as the standard operation to treat symptomatic aortic valvular diseases now.AVR can apparently improve the clinical symptoms and hemodynamics of patients with aortic valve stenosis or regurgitation.AVR has good effect and a higher long-term survival rate. Although transcatheter aortic valve implantation (TAVI) has also been accepted as an effective means to treat aortic valvular diseases, AVR is still the most reliable surgical procedure.Echocardiography is the most important method to diagnose aortic valve stenosis or regurgitation.Echocardiography is also a safe and reliable non-invasive detecting technique, which has important value on having preoperative evaluation, determining operation indication, choosing operation procedure and judging prognosis.The early complications of AVR affect the prognosis of patients after the surgery.Echocardiography is the most widely used clinical methodology for detecting the early complications that occurred within 30 days after the surgical procedure of AVR.Conventional echocardiography is most widely used, but new echocardiographic techniques such as tissue Doppler imaging(TDI), two-dimensional or three-dimensional speckle tracking imaging (2D or 3D-STI) and stress echocardiography are getting more and more attentive in recent years.However, there isn′t enough sufficient evidence to prove the predictive value of echocardiography on early complications after AVR.This article reviewed echocardiographic detective methods of main early complications after AVR, which may provide evidence to study the predictive value of preoperative echocardiographic index on early postoperative complications.

Key words: Aortic valve replacement, Echocardiography, Early complications
表1 2009-2012年国外文献报告的主动脉瓣置换术术后早期主要并发症发生率(%)
第一作者 例数 年龄(岁) 术后30d内死亡 围手术期心肌梗死 低心排综合征 完全性房室传导阻滞或需要永久性起搏器植入 持续性心房颤动 卒中或脑血管意外 肾功能不全或需要血液透析 使用IABP或ECMO 辅助通气时间延长
Calvo[5] 104 3.8 2.9 － 5.8 10.6 5.8 － 7.7 － －
Di Eusanio[6] 2540 <80 2.0 0.2 － 2.2 25.4 0.6 2.9 － 2.4
? 638 ≥80 4.5 0.3 － 4.4 33.9 1.3 4.9 － 3.4
Saxena[2] 2259 <80 2.0 0.4 － 1.2 － 1.0 4.2 － 7.1
? 531 ≥80 4.0 0.6 － 4.0 － 2.3 11.7 － 12.4
Kim[8] 36(单纯AVR) 0.0 － － － 25.0 0.0 0.0 0.0 5.5
? 50(复杂AVR) 0.0 － － － 18.0 0.0 0.0 0.0 8.0
Nicolini[7] 165 ? 3.0 0.0 4.0 － － 0.0 14.5 － 14.0
Bang[9] 73(传统AVR) 2.7 － 11.0 2.6 5.2 2.6 1.4 － －
? 73(微创AVR) 0.0 － 5.5 3.7 7.4 1.2 2.7 － －
图1 二维斑点追踪显像左室纵向应变、径向应变和环向应变测定
图2 左心室17节段应变峰值牛眼图比较
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