Unidad de Imagen Cardiovascular, Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain.
Rev Esp Cardiol. 2010 Mar;63(3):352-6. doi: 10.1016/s1885-5857(10)70069-4.
Degenerative aortic stenosis is the most common valvulopathy in Europe. In symptomatic patients, aortic valve replacement with a prosthesis substantially improves prognosis. However, a high percentage of candidates for valve replacement surgery are rejected because of the high risk of serious complications. In recent years, percutaneous and minimally invasive surgical techniques have been developed for the transcatheter implantation of prosthetic aortic valves. These developments could lead to an increase in the number of interventions carried out in high-risk patients as the positive effect of treatment on prognosis would be retained while the complication rate would be reduced. We describe the use of transesophageal echocardiography (TEE) for intraoperative monitoring in 21 patients who underwent transcatheter aortic valve replacement using an transapical approach, and report morphologic findings, hemodynamic results, and complications observed. We propose a standard approach to imaging, in which real-time three-dimensional TEE is used to provide additional information during intraoperative monitoring of transapical transcatheter aortic valve replacement.
退行性主动脉瓣狭窄是欧洲最常见的瓣膜病。在有症状的患者中，主动脉瓣置换术用假体显著改善了预后。然而，由于严重并发症的高风险，很大比例的瓣膜置换手术候选人被拒绝。近年来，经皮和微创手术技术已被开发用于经导管植入人工主动脉瓣。这些发展可能会导致高危患者的介入数量增加，因为治疗对预后的积极影响将保持，而并发症发生率将降低。我们描述了在 21 例经心尖入路行经导管主动脉瓣置换术的患者中使用经食管超声心动图（TEE）进行术中监测的情况，并报告了所观察到的形态学发现、血流动力学结果和并发症。我们提出了一种成像的标准方法，其中实时三维 TEE 用于在经心尖经导管主动脉瓣置换术的术中监测期间提供额外信息。
