经导管主动脉瓣置换术后有效瓣口面积评估准确性的提高：左心室流出道直径和脉冲波多普勒位置的验证及三维测量的影响。
Improving the accuracy of effective orifice area assessment after transcatheter aortic valve replacement: validation of left ventricular outflow tract diameter and pulsed-wave Doppler location and impact of three-dimensional measurements.
机构信息
Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York.
Morristown Medical Center, Morristown, New Jersey.
出版信息
J Am Soc Echocardiogr. 2015 Nov;28(11):1283-93. doi: 10.1016/j.echo.2015.07.010. Epub 2015 Aug 29.
BACKGROUND
Echocardiographic calculation of effective orifice area (EOA) after transcatheter aortic valve replacement is integral to the assessment of transcatheter heart valve (THV) function. The aim of this study was to determine the most accurate method for calculating the EOA of the Edwards SAPIEN and SAPIEN XT THVs.
METHODS
One hundred intraprocedural transesophageal echocardiograms were analyzed. To calculate the post-transcatheter aortic valve replacement left ventricular outflow tract (LVOT) stroke volume (SV), four diameters were measured using two-dimensional echocardiography: (1) baseline LVOT diameter (LVOTd_PRE), (2) postimplantation LVOT diameter, (3) native aortic annular diameter, and (4) THV in-stent diameter. Four corresponding areas were planimetered by three-dimensional echocardiography. Two LVOT velocity-time integrals (VTI) were measured with the pulsed-wave Doppler sample volume at (1) the proximal (apical) edge of the valve stent or (2) within the valve stent at the level of the THV cusps. LVOT velocity-time integral with the sample volume at the proximal edge of the valve stent was used with the LVOT and aortic annular measurements above, whereas in-stent VTI was paired with the in-stent THV diameter to yield eight different SVs. Right ventricular outflow tract (RVOT) SV was calculated using RVOT diameter and RVOT VTI and was used as the primary comparator. Transaortic VTI was obtained by continuous-wave Doppler, and EOA calculations using each SV measurement were compared with (1) EOA calculated using RVOTSV and (2) planimetered aortic valve area using three-dimensional echocardiography (AVAplanimetry3D).
RESULTS
Post-transcatheter aortic valve replacement EOA calculated using LVOTd_PRE was not significantly different from EOA calculated using RVOTSV (1.88 ± 0.33 vs 1.86 ± 0.39 cm(2), P = .36) or from AVAplanimetry3D (1.85 ± 0.28, P = .38, n = 34). All other two-dimensional EOA calculations were statistically larger than EOA calculated using RVOTSV. All three-dimensional echocardiography-based EOA calculations were statistically different from AVAplanimetry3D.
CONCLUSIONS
The most accurate EOA after implantation of a balloon-expandable THV is calculated using preimplantation LVOT diameter and VTI.
背景
经导管主动脉瓣置换术后，超声心动图计算有效开口面积（EOA）是评估经导管心脏瓣膜（THV）功能的重要指标。本研究旨在确定计算 Edwards SAPIEN 和 SAPIEN XT THV 的 EOA 的最准确方法。
方法
分析了 100 例经食管超声心动图。为了计算经导管主动脉瓣置换术后左心室流出道（LVOT）的每搏输出量（SV），使用二维超声心动图测量了四个直径：（1）LVOT 基础直径（LVOTd_PRE），（2）植入后 LVOT 直径，（3）固有主动脉瓣环直径，（4）THV 支架内直径。使用三维超声心动图对四个相应的区域进行描绘。使用脉冲波多普勒取样容积测量了两个 LVOT 速度时间积分（VTI）：（1）瓣架的近端（心尖）边缘，（2）瓣架内水平的瓣环。LVOT 速度时间积分采用瓣架近端取样容积，与上述 LVOT 和主动脉瓣环测量值相结合，而支架内 VTI 与支架内 THV 直径相结合，得出八个不同的 SV。右心室流出道（RVOT）SV 使用 RVOT 直径和 RVOT VTI 计算，并作为主要比较对象。通过连续波多普勒获得经主动脉 VTI，并将每种 SV 测量值的 EOA 计算值与（1）使用 RVOTSV 计算的 EOA 和（2）使用三维超声心动图（AVAplanimetry3D）描绘的主动脉瓣面积进行比较。
结果
LVOTd_PRE 计算的经导管主动脉瓣置换术后 EOA 与使用 RVOTSV 计算的 EOA（1.88 ± 0.33 比 1.86 ± 0.39 cm²，P =.36）或使用 AVAplanimetry3D 计算的 EOA （1.85 ± 0.28，P =.38，n = 34）无显著差异。所有其他二维 EOA 计算值均明显大于使用 RVOTSV 计算的值。所有基于三维超声心动图的 EOA 计算值均与 AVAplanimetry3D 显著不同。
结论
球囊扩张型 THV 植入后最准确的 EOA 使用植入前 LVOT 直径和 VTI 计算。
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