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世界首例无造影剂三尖瓣瓣周漏介入封堵术

2014-12-02 伟锋 于姣 医学论坛网

讯(伟锋 于姣)近日,第四军医大学西京医院心脏外科为1例高龄心肾功能不全患者,在不使用造影剂的条件下实施三瓣膜置换术后三尖瓣瓣周漏介入封堵术。 患者李伟(化名)来自西安市,今年76岁,主动脉瓣、二尖瓣、三尖瓣生物瓣置换术后12年出现三尖瓣瓣周漏,因长期心功能不全,导致心衰症状明显,出现胸闷、气短、双下肢水肿,极度消瘦等病症,体重仅70斤,且患有严重的肾功能不全。入院后,经超声心动图检查明确诊断为

(伟锋 于姣)近日,第四军医大学西京医院心脏外科为1例高龄心肾功能不全患者,在不使用造影剂的条件下实施三瓣膜置换术后三尖瓣瓣周漏介入封堵术。

患者李伟(化名)来自西安市,今年76岁,主动脉瓣、二尖瓣、三尖瓣生物瓣置换术后12年出现三尖瓣瓣周漏,因长期心功能不全,导致心衰症状明显,出现胸闷、气短、双下肢水肿,极度消瘦等病症,体重仅70斤,且患有严重的肾功能不全。入院后,经超声心动图检查明确诊断为三尖瓣瓣周漏,大量反流。患者年龄大,伴有严重心肾功能不全,恶液质,再次外科手术治疗已无可能。经会诊讨论,在心脏外科俞世强主任指导下,制定了周密的治疗方案,决定结合X线和超声引导,采用介入封堵方法治疗三尖瓣瓣周漏。由于患者严重肾功能不全,决定术中不使用造影剂,最大可能减少对肾脏功能损伤。

11月14日,经过周密术前准备,心脏外科杨剑副主任主刀实施手术。患者心功能差,心胸比0.72,右心系统严重扩大,心脏结构严重变异,瓣环显示不清,且不能使用造影剂,手术难度极大。杨剑副主任巧妙设计手术思路,通过穿刺股静脉的方式,采用可调控鞘及MPA导管,在经胸超声引导下,配合X线影像,通过瓣周漏,根据超声测量结果,选择置入一枚18/20mmPLUG封堵器,顺利完成手术。

释放封堵器后患者的静脉压从重度增高的40 mmHg将至轻度增高的20mmHg,术中造影剂使用量为零,避免了应用造影剂可能诱发的对比剂肾病,最大程度保护了患者肾脏功能。患者术后恢复良好,一般状况明显改善,术后5天顺利出院。

瓣膜置换术后瓣周漏是瓣膜置换手术的常见并发症,其发生率为0.5%-7%。三尖瓣瓣周漏较为罕见,常常引起右心系统功能不全,患者往往存在多脏器功能不全。传统外科手术治疗瓣膜术后瓣周漏,手术风险大、死亡率高、住院时间长、治疗费用高,且患者对再次开胸手术接受性较差。随着介入技术和相关耗材的进步,为治疗瓣膜置换术后瓣周漏提供了新思路。

心脏外科在俞世强主任指导下,自2013年起由杨剑副主任牵头开展了经导管瓣周漏介入封堵术,截至目前已完成此类手术30余例,先后开展老龄瓣周漏介入治疗、巨大瓣周漏介入治疗及多个封堵器瓣周漏介入治疗等高难手术。此例高龄严重心肾功不全三瓣膜置换术后三尖瓣瓣周漏患者,在不使用造影剂条件下完成手术,手术难度大,经查国内外未见类似报道。


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    2015-06-09 ycmayy
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  3. [GetPortalCommentsPageByObjectIdResponse(id=2060971, encodeId=373120609e130, content=<a href='/topic/show?id=e70046e74d3' target=_blank style='color:#2F92EE;'>#封堵术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=71, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=46774, encryptionId=e70046e74d3, topicName=封堵术)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c805395, createdName=ycmayy, createdTime=Tue Jun 09 23:50:00 CST 2015, time=2015-06-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1968427, encodeId=bc3e196842e3e, content=<a href='/topic/show?id=a57f208660f' target=_blank style='color:#2F92EE;'>#世界首例#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=161, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=20866, encryptionId=a57f208660f, topicName=世界首例)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=917c196, createdName=sjzlzc007, createdTime=Sun Jan 11 07:50:00 CST 2015, time=2015-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1493976, encodeId=04de14939e6fd, content=<a href='/topic/show?id=3e34949e333' target=_blank style='color:#2F92EE;'>#造影#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=144, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=94973, encryptionId=3e34949e333, topicName=造影)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=908d9134595, createdName=sodoo, createdTime=Thu Dec 04 01:50:00 CST 2014, time=2014-12-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1578445, encodeId=867215e84456a, content=<a href='/topic/show?id=a1021962883' target=_blank style='color:#2F92EE;'>#三尖瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=158, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=19628, encryptionId=a1021962883, topicName=三尖瓣)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c7cb16409801, createdName=124985dbm11(暂无昵称), createdTime=Thu Dec 04 01:50:00 CST 2014, time=2014-12-04, status=1, ipAttribution=)]
    2014-12-04 sodoo
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