阜外医院研究:感染性心内膜炎和血管炎是换瓣术后瓣周漏的重要原因

2018-10-27 xujing 中国循环杂志

阜外医院王浩、赵星等研究提示,有临床意义的瓣周漏是主动脉瓣置换术后的重要并发症,再手术比例高,复发率高,预后较差。


阜外医院王浩、赵星等研究提示,有临床意义的瓣周漏是主动脉瓣置换术后的重要并发症,再手术比例高,复发率高,预后较差。

主动脉瓣瓣周漏的原因以感染性心内膜炎最常见,其次为非特异性血管炎。

研究者分析了外科主动脉瓣置换术后有临床意义的瓣周漏患者123 例,年龄12~74 岁。所有患者入院行经胸或经食管超声心动图检查确诊瓣周漏。

28 例(22.8%)予内科保守治疗,95 例(77.2%)再次手术治疗。

本研究123 例患者中45 例有心内膜炎、27 例有血管炎,仅少数患者(17.8% 的心内膜炎患者、11.1% 的血管炎患者)在首次换瓣手术前已明确诊断

随访83例患者,超声心动图示仍有瓣周漏中量及以上反流者27 例,占32.5%,此比例在感染性心内膜炎患者和非特异性血管炎患者中更高,分别为38.5%和70.6%。

83例患者中免除瓣周漏相关并发症者仅有55 例。

瓣周漏患者超声心动图彩色多普勒可见舒张期源于人工瓣瓣周的反流信号,部分二维超声可见人工瓣缝合环与周围组织之间的裂隙。

原始出处:

赵星,王浩,高一鸣,等. 主动脉瓣置换术后瓣周漏的临床及超声心动图分析. 中国循环杂志, 2018, 33:485.

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