Noninvasive Cardiac Laboratory, Cedars-Sinai Heart Institute, Los Angeles, California.
Noninvasive Cardiac Laboratory, Cedars-Sinai Heart Institute, Los Angeles, California; University of California, Los Angeles, Los Angles, California.
JACC Cardiovasc Imaging. 2015 Sep;8(9):993-1003. doi: 10.1016/j.jcmg.2015.02.029. Epub 2015 Aug 26.
The purpose of this study was to determine which echocardiographic parameters, including holodiastolic flow reversal (HDFR) in the descending aorta, were useful for grading of post-procedural aortic regurgitation (PAR) after transcatheter aortic valve replacement (TAVR) using intraprocedural transesophageal echocardiography.
Reliable assessment of PAR in a catheterization laboratory is essential for an optimal outcome after TAVR; however, such an assessment has not been determined.
Three hundred eighty patients who underwent TAVR with the Edwards (Irvine, California) balloon-expandable transcatheter heart valve were retrospectively assessed by intraprocedural transesophageal echocardiography. PAR was evaluated by 2-dimensional color Doppler and pulse-wave Doppler in the descending aorta. Using 2-dimensional color Doppler, we measured the cross-sectional area of the vena contracta, the circumferential extent at the aortic annular plane, the longitudinal jet length, and the jet extent (with a mosaic pattern in the left ventricular outflow tract) compared with the location of the tip of the anterior mitral leaflet (AML). Grading of PAR was determined using the following vena contracta cutoffs: mild ≤9 mm(2); moderate 10 to 29 mm(2); and severe ≥30 mm(2). Significant PAR was defined as at least moderate grade.
All patients with consistent HDFR had significant PAR. By multivariable analysis, consistent HDFR and the jet extent beyond the tip of AML were independent predictors of significant PAR. Consistent HDFR and jet extent beyond the tip of AML predicted significant PAR with specificities of 100% and 97%, respectively. In contrast, patients with both negative HDFR and a jet extent of less than halfway to the tip of AML had no significant PAR, with 97% specificity.
The presence of consistent HDFR and jet extent beyond the tip of AML are indicative of significant PAR after TAVR.
本研究旨在确定哪些超声心动图参数，包括降主动脉中的全舒张期血流逆转（HDFR），对于经导管主动脉瓣置换术（TAVR）后使用术中经食管超声心动图分级术后主动脉瓣反流（PAR）有用。
在 TAVR 后进行导管室中 PAR 的可靠评估对于获得最佳结果至关重要；但是，尚未确定这种评估。
回顾性评估了 380 例接受 Edwards（加利福尼亚州欧文）球囊扩张经导管心脏瓣膜 TAVR 的患者，术中经食管超声心动图。使用二维彩色多普勒和脉冲波多普勒在降主动脉中评估 PAR。使用二维彩色多普勒，我们测量了收缩期的横截面积，在主动脉瓣环平面的周向延伸，纵向射流长度以及射流延伸范围（在左心室流出道中有镶嵌模式）与前二尖瓣叶（AML）尖端的位置。使用以下的收缩期横截面积切点确定 PAR 的分级：轻度≤9mm²；中度 10 至 29mm²；严重≥30mm²。显著的 PAR 定义为至少中度等级。
所有具有一致 HDFR 的患者均存在显著的 PAR。通过多变量分析，一致的 HDFR 和 AML 尖端以外的射流延伸是显著 PAR 的独立预测因子。一致的 HDFR 和 AML 尖端以外的射流延伸预测显著 PAR 的特异性分别为 100％和 97％。相比之下，具有负 HDFR 和射流延伸不到 AML 尖端一半的患者没有显著的 PAR，特异性为 97％。
一致的 HDFR 和 AML 尖端以外的射流延伸存在提示 TAVR 后存在显著的 PAR。
