心内超声心动图引导的经皮二尖瓣球囊扩张术:技术和早期经验

IF 1.4 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Ahmed Hassanin MD, MPH, Modar Alom MD, Srinivasa Potluri MD, Karim Al-Azizi MD
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引用次数: 0

摘要

背景经皮二尖瓣球囊扩张术(PMBC)是治疗无症状风湿性二尖瓣狭窄且瓣膜形态良好患者的金标准。心内超声(ICE)引导下的 PMBC 是标准经食道超声心动图引导的一种有吸引力的替代方法,可简化手术并避免全身麻醉。程序成功的定义是:PMBC 后二尖瓣口面积≥1.5 平方厘米;或二尖瓣口面积增加≥0.5 平方厘米,且超声心动图显示二尖瓣反流(MR)≤中度。结果我们确定了 11 名尝试在 ICE 引导下进行 PMBC 的受试者。受试者的平均年龄为 61.7 (±12.1) 岁。除一人外,其余均为女性。在这 11 名受试者中,有 2 人没有接受 PMBC;其中一人在 ICE 中发现基线严重 MV 返流,另一人在经椎动脉穿刺后出现心包积液,需要紧急进行心包开窗。所有接受 PMBC 的九名患者都取得了方案定义的手术成功。PMBC 术后的平均 MV 梯度为 4.4 (±2.0) mmHg,而基线时为 11.1 (±2.9) mmHg。在 6 个月的随访中,9 名患者中有 8 人的症状≤纽约心脏协会 II 级。与经食道超声心动图引导相比,ICE引导下的PMBC具有多项优势,包括提高患者舒适度、无需插管和全身麻醉。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intracardiac Echocardiography-Guided Percutaneous Mitral Balloon Commissurotomy: Technique and Early Experience

Background

Percutaneous mitral balloon commissurotomy (PMBC) is the gold standard for the treatment of patients with symptomatic rheumatic mitral valve (MV) stenosis and favorable valve morphology. Intracardiac ultrasound (ICE)-guided PMBC is an attractive alternative to standard transesophageal echocardiography guidance for simplification of procedure and avoiding general anesthesia.

Methods

We conducted a retrospective analysis of all ICE-guided PMBC cases at our institution between July 2020 and November 2023. Procedural success was defined as post-PMBC MV area ≥1.5 cm2; or an increase of ≥0.5 cm2 in MV area associated with echocardiographic mitral regurgitation (MR) that is ≤moderate post-PMBC. Six-month follow-up data were collected.

Results

We identified 11 subjects for whom ICE-guided PMBC was attempted. The mean age of the subjects was 61.7 (±12.1) years. All, but one, were females. Out of the 11 subjects, 2 did not undergo PMBC; one had baseline severe MV regurgitation identified on ICE, and the other developed a pericardial effusion following transeptal puncture that needed an urgent pericardial window. The protocol-defined procedural success was achieved in all nine patients who underwent PMBC. Post-PMBC mean MV gradient was 4.4 (±2.0) as compared to 11.1 (±2.9) mmHg at baseline. At 6-month follow-up, 8 of the 9 patients had ≤New York Heart Association class II symptoms.

Conclusions

ICE-guided PMBC appears to be feasible and safe. ICE-guided PMBC offers several advantages over transesophageal echocardiography guidance including improving patient comfort and eliminating the need for patient intubation and general anesthesia.

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来源期刊
Structural Heart
Structural Heart Medicine-Cardiology and Cardiovascular Medicine
CiteScore
1.60
自引率
0.00%
发文量
81
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