少见的介入瓣膜手术肺动脉瓣

,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,少见的介入瓣膜手术,肺动脉瓣,Samir Kapadia,MD,FACCAssociate Professor of MedicineDirector,Interventional Cardiology FellowshipCleveland Clinic,Disclosures:None,肺动脉瓣返流,(,右室流出道功能障碍,),先心病手术右室流出道功能障碍需行手术治疗比例升高,长期肺动脉瓣返流导致活动耐量下降，右心功能障碍和心律失常,(,房性,/,室性,),早期纠正肺动脉瓣返流可以改善右心功能,介入治疗适应症,返流百分比,30%,和持续多普勒监测右室流出道功能障碍峰速,16 mm,管道,功能障碍,纳入标准,NYHA II,III,IV,平均右室流出道功能障碍压差,35 mmHg,或,中重度肺动脉返流,NYHA I,平均右室流出道功能障碍,40 mmHg,或,重度,肺动脉返流合并右室扩张或功能障碍,*,右心室扩张的定义是三尖瓣瓣环直径,2.0,*,右心室功能障碍的定义是,右室面积变化,35 kg,管道 16mm,重度 肺动脉返流 3+或40%返流分数,有病症(心肺活动测试),绝大多数患者进行随访,Z.Hijazi,TCT 2021,Edward-Sapien,瓣膜,患者,年龄,:15-71,岁,诊断,:2,例为,Ross,术后,;5,例为法四术后,;1,例为,Rastelli,术后,术前压差为,30-75mmHg,肺动脉瓣关闭不全,:,重度,7,名患者既往行支架植入术,;1,名患者同时行支架植入,NYHA,分级,:2-3,Z.Hijazi,TCT 2021,Edward-Sapien,瓣膜,最初结果,8,名患者中，,7,名成功经皮输送,1,名患者，瓣膜位置不理想，瓣膜移位；手术取出和非体外循环下经心室瓣膜植入,急性压差下降,术前,10-40 mm Hg,术后,10-25 mm Hg,未出现肺动脉关闭不全,Z.Hijazi,TCT 2021,总结,目前，经皮肺动脉瓣置换术,效果令人鼓舞。,经皮肺动脉置换术的成功取决于患者的选择、影像学和密切随访,.,Less Common Interventional ValvesPulmonary Valve,Samir Kapadia,MD,FACCAssociate Professor of MedicineDirector,Interventional Cardiology FellowshipCleveland Clinic,Disclosures:None,Pulmonary Regurgitation(RVOT dysfunction),Need for intervention in RVOT dysfunction following congenital heart disease repair is increasing,Long standing pulmonary regurgitation leads to decreased exercise tolerance,RV dysfunction and arrhythmia(atrial/ventricular),Earlier correction of PR may preserve RV function,Indications for Intervention,Regurgitation Fraction 30%and RVOT peak velocity on continuous Doppler wave 16 mm,Conduit dysfunction,Study Inclusion Criteria,NYHA II,III,IV,Mean RVOT gradient 35 mmHg,or,Moderate or Severe PR,NYHA I,Mean RVOT gradient 40 mmHg,or,Severe PR with RV dilation*or dysfunction*,*RV dilatation defined as z-score for tricuspid annular diameter,2.0,*RV dysfunction defined as RV fractional area change 35 kg,Conduit 16mm,Severe PR 3+or 40%regurgitant fraction,Subject is symptomatic(CP exercise testing),Must comply with F/U,Z.Hijazi,TCT 2021,Edward-Sapien Valve ExperiencePatient Population,Age:15-71 years,DX:2 post Ross;5 post Tet;1 post Rastelli,Pre Gradient 30-75mmHg,PI:severe,7 patients had pre stenting;one had the stenting at the same time of the procedure,NYHA class:2-3,Z.Hijazi,TCT 2021,Edward-Sapien Valve ExperienceInitial Results,7/8 Successful percutaneous delivery,1/8:valve position was not ideal;valve migrated;surgical retrieval and“perventricular valve implantation off bypass,Acute Reduction of Gradients,pre 10-40 mm Hg,post 10-25 mm Hg,No PI,Z.Hijazi,TCT 2021,Summary,Initial Experience from percutaneous PV replacement is very encouraging.,It confirms the importance of patient selection,imaging and close follow up in the development of percutaneous therapies of valvular interventions.,