Interventional Cardiology, Cardiac Department, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.
EuroIntervention. 2012 Sep;8 Suppl Q:Q41-52. doi: 10.4244/EIJV8SQA9.
To understand the incidence, aetiology and mechanisms of paravalvular aortic and mitral leaks after valvular surgery; reviewing the best methods for diagnosis, procedural guidance and result assessment of these leaks, as well as describing the different approaches to their treatment.
A literature search was undertaken as well as an in-depth analysis of our own experience concerning different imaging modalities and various therapeutic strategies for aortic and mitral paravalvular leaks. The majority of patients were diagnosed using two- or three-dimensional transoesophageal echocardiography, useful in both guiding the procedure as well as assessing the procedural results. Haemoglobin, haematocrit, LDH and haptoglobin values were analysed to assess haemolysis. Procedural success for percutaneous closure of paravalvular aortic leaks are around 90% in the different series, with low complication rates. Mitral leaks have been approached by transfemoral and transapical access; the reported success of this procedure ranges from 75% to more than 90% in different reports. Complication rates at 30 days average 10% and mortality related to the procedure is around 1%. Late follow-up results depend on the initial anatomy, baseline clinical class and procedure results.
Paravalvular leaks after surgical valve implantation have a multifactorial aetiology, but are mainly related to specific anatomic characteristics of the valvular ring. Mitral leaks are three times more common than aortic leaks and the incidence increases after reoperation. Different percutaneous techniques with several devices have been explored for leak closure, but we are still lacking devices specifically designed to treat this pathology more effectively.
了解瓣膜手术后发生瓣周主动脉和二尖瓣漏的发生率、病因和机制；回顾这些漏的诊断、程序指导和结果评估的最佳方法，以及描述治疗这些漏的不同方法。
进行了文献检索，并深入分析了我们自己在不同成像方式和各种治疗策略方面的经验，以治疗主动脉瓣和二尖瓣瓣周漏。大多数患者通过二维或三维经食管超声心动图进行诊断，该方法既有助于指导手术，也有助于评估手术结果。分析血红蛋白、血细胞比容、乳酸脱氢酶和触珠蛋白值以评估溶血情况。经皮瓣周主动脉漏封堵术的成功率在不同系列中约为 90%，并发症发生率低。二尖瓣漏可通过经股动脉和经心尖途径进行治疗；不同报道中该手术的成功率在 75%至 90%以上。30 天的并发症发生率平均为 10%，与手术相关的死亡率约为 1%。晚期随访结果取决于初始解剖结构、基线临床分级和手术结果。
外科瓣膜植入术后瓣周漏的病因有多种，但主要与瓣环的特定解剖特征有关。二尖瓣漏比主动脉漏常见三倍，且在再次手术后发生率增加。已经探索了几种不同的经皮技术和多种器械来进行漏口封堵，但我们仍缺乏专门设计的器械来更有效地治疗这种病变。
