皮下三瓣阀修复期间回声导的简化步进方法
Summary
本协议详细介绍了如何在转导器膜瓣膜修复过程中执行实时超声心动图指导。对程序的每个阶段都描述了基本观点和必要的测量结果。
Abstract
皮质转导器边缘到边缘重建的三叶虫瓣膜是一种安全和成熟的治疗严重症状性皮质回流的患者与手术风险高。除了氟镜检查外，心电图指导是黄金标准，应采用标准化技术进行。
本文介绍了我们可重复的逐步声心电图指南，包括视图、测量以及突出过程中可能出现的困难。
本文为程序的每一步提供详细和按时间顺序排列的声心电图视图，尤其是 2D 和 3D 成像之间的首选项。如果需要，将描述脉冲波、连续波和彩色多普勒测量。此外，由于没有关于在皮边到边缘修复过程中量化线粒体回流的官方建议，因此在掌握线粒体传单和设备部署后，还包括了对超声心动图量化的建议。此外，本文还处理重要的回声心电图视图，以防止和处理手术过程中可能出现的并发症。
转导器三阀修复期间的回声心动图指导是强制性的。结构化方法可改善干预者和成像师之间的协作，对于安全有效的程序至关重要。
Introduction
三位一体性复发（MR）是欧洲第二频繁的瓣膜手术。未经治疗，它可能导致严重的心力衰竭和生活质量下降2，3，4。皮下皮瓣膜修复 （PMVR） 是一种基于导管的技术，它模仿阿尔菲耶里缝合手术方法，通过连接 A2 和 P2 扇贝5进行皮质修复。对于手术风险高的患者，该技术为治疗严重MRI提供了一种微创方法。 来自多个登记处和试验的数据表明，MitraClip程序，一种转导器三瓣修复疗法，是一种有效和安全的方法6，7，8，9。2019年，一种类似的设备PASCAL导管阀维修系统被引入市场。在治疗严重M10病人时，已显示出可行性及可接受的安全性。PMVR 的持续时间和成功取决于单个操作员的技能和经验11。与其他皮下技术相比，如皮外转体置换（TAVR），它只能用荧光镜检查，PMVR需要回声心电图指导12，13。
本文逐步描述了 PMVR 期间的回声心动图方法，包括测量、MR 的校内量化建议以及防止近视并发症的重要观点。
Protocol
该协议遵循我们机构的人类研究伦理委员会的指导方针。 1. 干预前的评估 在转射穿刺前排除腹产。如果存在小腹腔溢出，则测量四室 （4Ch） 视图中的最大端舒张回声发光空间，重点是右心室 （RV）、中食管右心室流入流出视图和长轴 （LAX） 视图。 评估左上肺静脉脉冲波多普勒 （PW） 的肺静脉流动模式，并排除左心房附属物 （LAA） 中的血栓形成。以 LAA 为?…
Representative Results
皮质边缘到边缘瓣膜修复是手术瓣膜修复或替代患者不符合有症状的严重MRI手术的替代方案。在血管内瓣边缘到边缘修复研究I（EVERESTI）14试验中，对MitraClip的首次临床应用进行了调查。许多其他试验已经证明了程序的有效性，症状的改善，以及低率的医院死亡率和不良事件（ACCESS EU，TRAMI，EVEREST II）15，16，17。<…
Discussion
PMVR 的回声引导是一种安全的方法。由于声心动图引起的并发症可能发生，但很少导致重大损害。然而，食管病变是可能的后，执行食管超声心动图。这种发生率在干预34的较短时间内减少。相反，与转导器边缘到边缘三边瓣膜修复相关的几个并发症被描述为35，36。大出血是输血后最常见的主要并发症，输血过程一直与死亡率<sup class="…
Divulgations
The authors have nothing to disclose.
Acknowledgements
我们感谢多萝西娅·舍伦女士的技术视频支持。
Materials
| EPIQ 7 Ultrasound System | Philips | US218B0542 | Cardiac Ultrasound Machine |
| X8-2t xMATRIX 3D-TEE probe | Philips | B34YYK | TEE-probe |
| Sheath 6F 25 cm | Merit Medical | B60N25AQ | Sheath |
| Dilator 16 F | Abbott | 405544 | Dilator |
| BRK-1 transseptal needle 71 cm | St. Jude Medical | ABVA407201 | Transseptal Needle |
| Swartz Lamp 90° | St. Jude Medical | 407356 | Transseptal Guiding Introducer Sheath |
| Amplatz super stiff | Kook Medical | 46509 | Wire |
| Steerable Guide Catheter | Abbott | SGC0302 | Steerable Guide Catheter |
| MitraClip NTR Delivery System | Abbott | CDS0602-NTR | Clip Delivery System |
| MitraClip NTR Bundle | Abbott | MSK0602-NTR | Device |
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Citer Cet Article
Gatti, A., Krieger, K., Seidel, M., Röttgen, A., Bruch, L. A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair. J. Vis. Exp. (176), e62053, doi:10.3791/62053 (2021).