【摘要】 目的：探讨经心尖经导管主动脉瓣置换术（TAVR）治疗主动脉瓣单纯关闭不全的近中期临床症状改善情况、左心室结构及功能等变化特点。方法：选取2018年1月至2019年6月在空军军医大学西京医院行经心尖途径TAVR治疗主动脉瓣单纯关闭不全的患者53例，随访1年，观察术后左心室各径线、主动脉生物瓣内和瓣周反流、二尖瓣反流程度等情况。采用单因素方差分析主动脉瓣前向峰值流速（AV-Vmax）、主动脉瓣峰值跨瓣压差（AV-PGmax）、主动脉瓣平均跨瓣压差（AV-PGmean）、左心房收缩末期前后径（LAESD）、左心室舒张末期后壁厚度(LVPWT)、左心室舒张末期前后径（LVEDD）、左心室舒张末期长径（LVEDL）、左心室舒张末期容积(LVEDV)、左心室收缩末期容积(LVESV)、左心室射血分数（LVEF）、二尖瓣峰值流速（MV-Vmax）、二尖瓣峰值跨瓣压差（MV-PGmax）等指标，比较术前与术后的变化。结果：53例患者中，术后12个月NYHA心功能Ⅱ级以下者由术前8例（15.1%）增加至42例（79.2%）,P<0.05。术后12个月NYHA心功能Ⅲ级以上11例患者中，有2例二尖瓣大量反流，其余9例患者LVEDD[(73.2±5.0)mm vs.(68.3±6.8)mm]及LVEF[(33.7±7.6)%vs.(35.7±9.8)%]术前与术后12个月比较差异均无统计学意义（P均> 0.05）。42例NYHA心功能Ⅱ级以下患者术后出院时（1周内）与术前比较LVEDD [(57.4±9.7)mm vs.(64.4±8.2)mm]及LVEDV[(149.1±63.8)ml vs.(190.0±60.2)ml]明显减小（P均<0.05）；术前与术后6个月比较LVESV[(105.6±47.9)ml vs.(77.1±56.6)ml]、LVEF[(41.6±9.7)%vs.(49.7±10.9)%]、LVPWT[(9.8±1.7)mm vs.(11.6±1.5)mm]差异均有统计学意义（P均<0.05）。53例患者术前与术后6个月比较AV-Vmax[(172.7±41.1)cm/svs.(191.9±39.4)cm/s]、AV-PGmax[(12.6±6.3)mmHg(1 mmHg=0.133 kPa)vs.(15.4±6.5)mmHg]及AVPGmean[(5.8±2.9)mmHgvs.(7.8±3.3)mmHg]差异均有统计学意义（P均<0.05）。术前16例合并继发性二尖瓣中量以上反流，术后出院时减少为7例。结论：主动脉瓣单纯关闭不全TAVR术后，左心室腔总体呈现明显缩小的趋势，二尖瓣关闭不全程度逐渐减轻，临床症状明显改善，并且LVEF也明显提高，呈现出左心室逆重构现象。更多还原

【Abstract】 Objectives: To investigate the improvement of clinical symptoms and the structure and function of left ventricle after apical approach transcatheter aortic valve replacement(TAVR) in the treatment of patients with isolated aortic insufficiency.Methods: A total of 53 patients with isolated aortic insufficiency treated by TAVR via apical approach from January 2018to June 2019 in Xijing Hospital, Air Force Military Medical University were included in this study. The patients were followed up for 1 year, and the postoperative left ventricular dimensions, intra-aortic biological valve regurgitation, perivalvular leakage and mitral regurgitation were observed by echocardiography. The changes of aortic valve maximum velocity(AV-Vmax),aortic valve maximum pressure gradient(AV-PGmax), aortic valve mean pressure gradient(AV-PGmean), left atrial endsystolic diameter(LAESD), left ventricular end-diastolic posterior wall thickness(LVPWT), left ventricular end-diastolic diameter(LVEDD), left ventricular end-diastolic length(LVEDL), left ventricular end-diastolic volume(LVEDV), left ventricular end-systolic volume(LVESV), left ventricular ejection fraction(LVEF), mitral valve maximum velocity(MVVmax), mitral valve maximum pressure gradient(MV-PGmax) before and after operation were compared.Results: At 12 months after operation, patients with the NYHA classification below grade Ⅱ increased from 8 cases(15.1%) to 42 cases(79.2%, P<0.05). Among the 11 patients with postoperative NYHA classification grade Ⅲ and Ⅳ,2 patients had severe mitral regurgitation. There was no significant difference in LVEDD([73.2±5.0]mm vs.[68.3±6.8]mm) and LVEF([33.7±7.6]% vs. [35.7±9.8]%) between before and at 12 months after operation in the remaining 9patients(both P>0.05). Compared with preoperative level, data from the 42 patients with NYHA classification below grade Ⅱ showed that LVEDD( [64.4±8.2]mm vs. [57.4±9.7]mm) and LVEDV([190.0±60.2]ml vs.[149.1±63.8]ml) were significantly decreased at hospital discharge(within 1 week, P <0.05); LVESV([105.6±47.9]ml vs. [77.1±56.6]ml),LVEF([41.6±9.7] % vs. [49.7±10.9 ]%), LVPWT( [9.8±1.7]mm vs. [11.6±1.5]mm), were significantly different at 6 months post TAVR(all P<0.05). 53 patients AV-Vmax([172.7±41.1]cm/s vs.[191.9±39.4 ]cm/s), AV-PGmax([12.6±6.3] mmHg [1 mmHg=0.133 kPa] vs. [15.4±6.5]mmHg), AV-PGmean([5.8±2.9] mmHg vs. [7.8±3.3]mmHg) were significantly different at 6 months post TAVR(all P<0.05). There were 16 patients with secondary mitral regurgitation before operation, and which as reduced to 7 patients at the time of postoperative discharge.Conclusions: After TAVR, the overall left ventricular dimensions are significantly reduced, the degree of mitral valve insufficiency is also gradually reduced, the clinical symptoms are significantly improved, and LVEF is significantly increased, thus our results indicate that TAVR induces left ventricular reverse remodeling in patients with isolated AR.更多还原