使用实时三维经食管超声心动图优化二尖瓣经皮缘对缘修复术的指导。
Optimized guidance of percutaneous edge-to edge repair of the mitral valve using real-time 3-D transesophageal echocardiography.
机构信息
Medical Clinic I, University RWTH Aachen, Pauwelsstraße 30, 52057, Aachen, Germany.
出版信息
Clin Res Cardiol. 2011 Aug;100(8):675-81. doi: 10.1007/s00392-011-0296-1. Epub 2011 Mar 3.
BACKGROUND
Percutaneous edge-to-edge repair with the MitraClip device has been shown to allow effective treatment of mitral regurgitation. It is mainly guided by transesophageal echocardiography while fluoroscopic guidance is of less importance. The impact of real-time three-dimensional transesophageal echocardiography (RT 3-D TEE) for guidance of this complex interventional procedure has not been evaluated.
METHODS
In 28 high-surgical risk patients with moderate or severe mitral regurgitation (mean age 67 ± 10 years; 15 male), 2-D and RT 3-D TEE were used for the guidance of percutaneous edge-to-edge mitral valve repair using the MitraClip device. We performed a structured analysis to compare information and guidance capacity provided by RT 3-D TEE compared to 2-D TEE.
RESULTS
RT 3-D TEE was found to provide advantages in 9 of 11 steps of the percutaneous mitral repair procedure. The advantages related to optimized definition of the transseptal puncture site, improved guidance of the clip delivery system towards the mitral valve, precise positioning of the clip delivery system simultaneously in anterior-posterior and lateral-medial direction above the mitral valve considering mitral valve scallops A2 and P2 and valvular regurgitation jet position, adjustment of the opened clip-arms perpendicular to the commissural line, visualization of the clip position relative to the valvular orifice and of the remaining regurgitant jet after clip closure from atrial as well as ventricular views providing double orifice images and thereby allowing confirmation or rejection of clip position in medial-lateral direction. RT 3-D TEE was inferior to 2-D TEE for leaflet grasping and analysis of leaflet insertion.
CONCLUSION
In complex interventional edge-to-edge repair with the MitraClip device requiring optimal spatial information RT 3-D TEE allows improved guidance of the procedure. RT 3-D TEE guidance compared with 2-D TEE guidance alone resulted in greater operator confidence to adequately perform the procedure.
背景
经皮缘对缘修复术联合 MitraClip 装置已被证实可有效治疗二尖瓣反流。该手术主要通过经食管超声心动图引导，而荧光透视引导的作用则相对较小。实时三维经食管超声心动图（RT 3-D TEE）在指导这种复杂介入治疗中的作用尚未得到评估。
方法
在 28 例高手术风险、中重度二尖瓣反流患者（平均年龄 67 ± 10 岁；男性 15 例）中，我们使用 2-D 和 RT 3-D TEE 引导经皮缘对缘二尖瓣修复术，采用 MitraClip 装置。我们进行了一项结构分析，以比较 RT 3-D TEE 与 2-D TEE 提供的信息和指导能力。
结果
在经皮二尖瓣修复术的 11 个步骤中，RT 3-D TEE 有 9 个步骤具有优势。这些优势与经间隔穿刺部位的优化定义、夹合器输送系统向二尖瓣的引导、在二尖瓣前瓣 A2 和后瓣 P2 以及瓣环反流射流位置上方同时进行的夹合器输送系统的前后和内外侧定位、夹合器臂与交界线垂直的调整、夹合器位置相对于瓣口和夹闭后剩余反流射流的心房和心室视图的可视化、提供双孔图像并允许在内外侧方向确认或拒绝夹合器位置有关。RT 3-D TEE 在瓣叶抓取和瓣叶插入分析方面逊于 2-D TEE。
结论
在需要优化空间信息的复杂经皮缘对缘修复术联合 MitraClip 装置中，RT 3-D TEE 可改善手术引导。与单纯 2-D TEE 引导相比，RT 3-D TEE 引导可增强操作者的信心，从而更充分地完成手术。
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