Hays Janet, Lujan Michael, Chilton Robert
University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA.
J Invasive Cardiol. 2006 Jun;18(6):262-7.
To evaluate the accuracy of a new long sheath single-puncture technique in obtaining accurate transvalvular gradients in aortic stenosis.
Despite advances in echo Doppler, the evaluation of aortic stenosis continues to be a common procedure in the cardiac catheterization laboratory. Experts agree that simultaneous evaluation of the proximal aortic and left ventricular pressures yields the most accurate data; however, this is difficult to achieve unless two arterial punctures are performed.
We postulated that using a 4 Fr pigtail catheter inside a 55-cm long 6 Fr sheath would provide accurate simultaneous pressure data, yet avoid the complications of two arterial punctures. We performed this technique in 13 male patients, and placed a second arterial catheter in the aortic root as a control aortic pressure. We then performed this technique in 55 other male patients without placing an additional control arterial catheter.
In the test population, correlation of aortic valve areas and transvalvular gradients was excellent. In the larger population, adequate hemodynamic data was obtained in 52 patients, with no difficulty engaging coronary arteries or grafts via the long sheath, and with an acceptable major complication rate of 1.5%.
Using a 4 Fr pigtail catheter with a 55-cm long 6 Fr sheath is a safe, efficient way to obtain excellent hemodynamic data in an aortic stenosis catheterization procedure.
评估一种新的长鞘单穿刺技术在获取主动脉瓣狭窄精确跨瓣压差方面的准确性。
尽管超声多普勒技术有所进步，但在心脏导管实验室中，主动脉瓣狭窄评估仍是常见操作。专家们一致认为，同时评估近端主动脉和左心室压力可得出最准确的数据；然而，除非进行两次动脉穿刺，否则很难做到这一点。
我们推测，在一根55厘米长的6F鞘管内使用一根4F猪尾导管可提供准确的同步压力数据，同时避免两次动脉穿刺的并发症。我们对13名男性患者实施了该技术，并在主动脉根部置入第二根动脉导管作为对照主动脉压力。然后，我们对另外55名男性患者实施了该技术，未额外置入对照动脉导管。
在测试人群中，主动脉瓣面积与跨瓣压差的相关性极佳。在更大的人群中，52名患者获得了足够的血流动力学数据，通过长鞘管进入冠状动脉或移植血管没有困难，主要并发症发生率为1.5%，可以接受。
在主动脉瓣狭窄导管插入术中，使用带有55厘米长6F鞘管的4F猪尾导管是获取优秀血流动力学数据的一种安全、有效的方法。
