Eidet Jo, Dahle Gry, Bugge Jan F, Bendz Bjørn, Rein Kjell A, Fosse Erik, Aakhus Svend, Halvorsen Per S
The Intervention Centre, Rikshospitalet, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Norway.
Department of Cardiothoracic Surgery, Rikshospitalet, Oslo University Hospital, Oslo, Norway.
J Cardiothorac Vasc Anesth. 2015 Feb;29(1):115-20. doi: 10.1053/j.jvca.2014.10.016.
Transcatheter aortic valve implantation in patients turned down for surgical aortic valve replacement is a high-risk procedure. Severe aortic stenosis is associated with impaired left ventricular longitudinal motion, and myocardial peak systolic velocity is a measure of left ventricular function in these patients. The present study aimed to quantify the acute changes in left ventricular function during the procedure by using myocardial tissue Doppler imaging and transthoracic cardiac output measurements.
Prospective observational study.
Tertiary care university hospital.
40 patients with severe aortic stenosis scheduled for transcatheter aortic valve implantation.
Transesophageal 4-chamber and 2-chamber echocardiograms were performed immediately before and ~15 minutes after valve implantation. Longitudinal myocardial peak systolic velocity was obtained by tissue Doppler imaging from 8 basal segments and averaged. Cardiac output was measured by the lithium dilution method, and systemic vascular resistance index and stroke volume were calculated.
Longitudinal myocardial peak systolic velocity improved immediately after valve implantation, from -2.3±0.8 to -3.0±1.1 cm/sec (p<0.001); this represented an average increase of 31%±33%. Cardiac output increased from 3.2±0.8 L/min to 3.6±0.9 L/min (15%±33%; p = 0.04). This was due to increased heart rate (59±9 beats/min to 72±12 beats/min; p<0.001) and not to an improved stroke volume. Systemic vascular resistance index was reduced from 2,937±984 dynessec/cm(5)/m(2) to 2,436±730 dynessec/cm(5)/m(2) (p = 0.003).
Intraoperative echocardiography tissue Doppler imaging detected immediate improvement in left ventricular long-axis motion after transcatheter aortic valve implantation. The method provided detailed information not obtainable by routine hemodynamic monitoring.
对于那些拒绝接受外科主动脉瓣置换术的患者，经导管主动脉瓣植入术是一项高风险手术。严重主动脉瓣狭窄与左心室纵向运动受损有关，心肌收缩期峰值速度是衡量这些患者左心室功能的指标。本研究旨在通过使用心肌组织多普勒成像和经胸心输出量测量来量化手术过程中左心室功能的急性变化。
前瞻性观察研究。
三级医疗大学医院。
40例计划行经导管主动脉瓣植入术的严重主动脉瓣狭窄患者。
在瓣膜植入前即刻和植入后约15分钟进行经食管四腔心和两腔心超声心动图检查。通过组织多普勒成像从8个基底节段获取纵向心肌收缩期峰值速度并求平均值。采用锂稀释法测量心输出量，并计算全身血管阻力指数和每搏输出量。
瓣膜植入后即刻纵向心肌收缩期峰值速度得到改善，从-2.3±0.8 cm/秒提高到-3.0±1.1 cm/秒（p<0.001）；这代表平均增加了31%±33%。心输出量从3.2±0.8升/分钟增加到3.6±0.9升/分钟（15%±33%；p = 0.04）。这是由于心率增加（从59±9次/分钟增加到72±12次/分钟；p<0.001），而非每搏输出量改善。全身血管阻力指数从2937±984达因·秒/厘米⁵/米²降至2436±730达因·秒/厘米⁵/米²（p = 0.003）。
术中超声心动图组织多普勒成像检测到经导管主动脉瓣植入术后左心室长轴运动立即改善。该方法提供了常规血流动力学监测无法获得的详细信息。
