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计算机断层扫描在经导管置换“其他瓣膜”中的作用:术前成像的综合评价。

Role of computed tomography in transcatheter replacement of 'other valves': a comprehensive review of preprocedural imaging.

机构信息

Department of Biomedicine and Prevention, Division of Diagnostic Imaging, University of Rome Tor Vergata and Unit of Diagnostic Imaging.

Department of System Medicine, University of Rome Tor Vergata and Unit of Cardiology and Interventional Cardiology, Policlinico Tor Vergata, Rome, Italy.

出版信息

J Cardiovasc Med (Hagerstown). 2022 Sep 1;23(9):575-588. doi: 10.2459/JCM.0000000000001362. Epub 2022 Aug 17.


DOI:10.2459/JCM.0000000000001362
PMID:35994705
Abstract

Transcatheter procedures for heart valve repair or replacement represent a valid alternative for treating patients who are inoperable or at a high risk for open-heart surgery. The transcatheter approach has become predominant over surgical intervention for aortic valve disease, but it is also increasingly utilized for diseases of the 'other valves', that is the mitral and, to a lesser extent, tricuspid and pulmonary valve. Preprocedural imaging is essential for planning the transcatheter intervention and computed tomography has become the main imaging modality by providing information that can guide the type of treatment and choice of device as well as predict outcome and prevent complications. In particular, preprocedural computed tomography is useful for providing anatomic details and simulating the effects of device implantation using 3D models. Transcatheter mitral valve replacement is indicated for the treatment of mitral regurgitation, either primary or secondary, and computed tomography is crucial for the success of the procedure. It allows evaluating the mitral valve apparatus, the surrounding structures and the left heart chambers, identifying the best access route and the landing zone and myocardial shelf, and predicting obstruction of the left ventricular outflow tract, which is the most frequent postprocedural complication. Tricuspid valve regurgitation with or without stenosis and pulmonary valve stenosis and regurgitation can also be treated using a transcatheter approach. Computer tomography provides information on the tricuspid and pulmonary valve apparatus, the structures that are spatially related to it and may be affected by the procedure, the right heart chambers and the right ventricular outflow tract.

摘要

经导管心脏瓣膜修复或置换术是治疗手术高危或不能手术的患者的有效替代方法。经导管方法已成为主动脉瓣疾病治疗的首选方法,但也越来越多地用于治疗“其他瓣膜”疾病,即二尖瓣,以及在较小程度上的三尖瓣和肺动脉瓣。术前成像对于规划经导管干预至关重要,计算机断层扫描已成为主要的成像方式,可提供指导治疗类型和器械选择的信息,以及预测结果和预防并发症。特别是,术前计算机断层扫描有助于提供解剖细节,并使用 3D 模型模拟器械植入的效果。经导管二尖瓣置换术适用于治疗原发性或继发性二尖瓣反流,计算机断层扫描对于手术的成功至关重要。它可以评估二尖瓣装置、周围结构和左心腔,确定最佳进入途径和着陆区以及心肌架,并预测左心室流出道阻塞,这是最常见的术后并发症。三尖瓣反流伴或不伴狭窄以及肺动脉瓣狭窄和反流也可以采用经导管方法治疗。计算机断层扫描提供有关三尖瓣和肺动脉瓣装置、与它空间相关并可能受该程序影响的结构、右心腔和右心室流出道的信息。

相似文献

[1]
Role of computed tomography in transcatheter replacement of 'other valves': a comprehensive review of preprocedural imaging.

J Cardiovasc Med (Hagerstown). 2022-9-1

[2]
Transseptal transcatheter mitral valve-in-valve: A step by step guide from preprocedural planning to postprocedural care.

Catheter Cardiovasc Interv. 2017-5-30

[3]
Validating a prediction modeling tool for left ventricular outflow tract (LVOT) obstruction after transcatheter mitral valve replacement (TMVR).

Catheter Cardiovasc Interv. 2018-8-1

[4]
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Circ Cardiovasc Interv. 2018-10

[5]
Transcatheter Mitral Valve Replacement for Degenerated Bioprosthetic Valves and Failed Annuloplasty Rings.

Surg Technol Int. 2020-11-28

[6]
Long or redundant leaflet complicating transcatheter mitral valve replacement: Case vignettes that advocate for removal or reduction of the anterior mitral leaflet.

Catheter Cardiovasc Interv. 2017-5-4

[7]
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Int J Cardiovasc Imaging. 2024-6

[8]
Balloon assisted translocation of the mitral anterior leaflet to prevent left ventricular outflow obstruction (BATMAN): A novel technique for patients undergoing transcatheter mitral valve replacement.

Catheter Cardiovasc Interv. 2019-9-13

[9]
CT for Pre- and Postprocedural Evaluation of Transcatheter Mitral Valve Replacement.

Radiographics. 2020-10

[10]
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JACC Cardiovasc Interv. 2017-8-28

引用本文的文献

[1]
Cardiac tissue engineering: an emerging approach to the treatment of heart failure.

Front Bioeng Biotechnol. 2024-8-15

[2]
Advances in Imaging for Tricuspid Transcatheter Edge-to-Edge Repair: Lessons Learned and Future Perspectives.

J Clin Med. 2023-5-10

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