Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.
EuroIntervention. 2017 Oct 13;13(9):e1067-e1075. doi: 10.4244/EIJ-D-17-00373.
This study aimed to assess the potential relationship between subclinical leaflet thickening and stent frame geometry in patients who underwent aortic valve replacement with a self-expanding transcatheter heart valve (THV).
Seventy-five patients with a self-expanding THV were studied with 4D-computed tomography and analysed for leaflet thickening. There was no difference in THV size, overall THV expansion, eccentricity or implantation depth between patients with and those without leaflet thickening. Moderate-to-severe regional THV underexpansion (≤90°) more frequently occurred at the non-coronary and right coronary cusps with a significantly higher incidence of leaflet thickening than in cases of full regional THV expansion (24% vs. 3%, p<0.01). Regional THV underexpansion at the inflow level more often translated into the same issue at the valvular level in THV with intra-annular as compared to supra-annular valve position (54% vs. 17%; p=0.04). In case of post-dilatation, regional THV underexpansion occurred less frequently as compared to THV that were not post-dilated (18% vs. 43%, p=0.028). A similar but non-significant trend was found for leaflet thickening.
Regional THV stent frame underexpansion is associated with an increased risk of leaflet thickening. Post-dilatation of self-expanding THV as well as a supra-annular valve position seem to reduce the occurrence of this phenomenon.
本研究旨在评估在接受自膨式经导管心脏瓣膜（THV）主动脉瓣置换术的患者中，瓣叶增厚与支架框架几何形状之间的潜在关系。
对 75 例接受自膨式 THV 的患者进行了 4D-计算机断层扫描，并对瓣叶增厚进行了分析。瓣叶增厚患者与无瓣叶增厚患者的 THV 大小、整体 THV 扩张程度、偏心度或植入深度无差异。非冠状动脉和右冠状动脉瓣叶的中度至重度区域性 THV 扩张不足（≤90°）较常见，瓣叶增厚的发生率明显高于完全区域性 THV 扩张（24%比 3%，p<0.01）。与瓣环上位置的 THV 相比，瓣环内位置的 THV 在流入水平的区域性 THV 扩张更常导致瓣膜水平出现相同的问题（54%比 17%；p=0.04）。与未行后扩张的 THV 相比，行后扩张的 THV 发生区域性 THV 扩张不足的情况较少（18%比 43%，p=0.028）。瓣叶增厚也出现类似但无统计学意义的趋势。
区域性 THV 支架框架扩张不足与瓣叶增厚的风险增加相关。自膨式 THV 的后扩张以及瓣环上位置似乎可以降低这种现象的发生。
