经导管二尖瓣置换术 (TMVR): 环形或心尖固定？
- 作者列表："Lutter G","Dai H","Hansen JH","Frank D","Haneya A","Simionescu D","Cremer J","Puehler T
AIMS:The aim of this study was to evaluate the impact of two different transcatheter mitral valve replacement (TMVR) fixation strategies on the neo left ventricular outflow tract (neo-LVOT) and aorto-mitral angulation (AMA) after TMVR. METHODS AND RESULTS:Two different self-expanding nitinol valved stents were developed for transapical TMVR. In one group, the stents were fixed with an annular fixation system (ANN group, n=6). These prototypes were compared with an apical tether fixation TMVR system (AP group, n=11) in another group. Echocardiographic evaluation of the AMA and the neo-LVOT was conducted before and one hour after implantation. Maximal and minimal AMA (AMAmax and AMAmin) during the cardiac cycle of the AP group were significantly narrower than those of the ANN group (AMAmax: 39±8° vs 67±15°, p<0.001, AMAmin: 33±10° vs 56±22°, p=0.009). More severe reduction of the neo-LVOT diameter was observed in the ANN group (60±11% vs 26±14%, p<0.001). The ANN group had a higher peak velocity through the neo-LVOT post implantation (200±52 cm/s vs 108±15 cm/s, p<0.001). CONCLUSIONS:The apical fixation system maintains a smaller and more stable aorto-mitral angulation and a larger neo-LVOT, thereby reducing the risk of postoperative neo-LVOT obstruction in this experimental setting.
目的: 本研究的目的是评估两种不同的经导管二尖瓣置换术 (TMVR) 固定策略对TMVR后新左心室流出道 (neo-LVOT) 和主动脉-二尖瓣成角 (AMA) 的影响。 方法和结果: 开发了两种不同的自扩张镍钛合金瓣膜支架用于经心尖TMVR。一组用环形固定系统固定支架 (ANN组，n = 6)。将这些原型与另一组中的顶端系绳固定TMVR系统 (AP组，n = 11) 进行比较。植入前和植入后1小时进行AMA和neo-LVOT的超声心动图评估。AP组在心动周期中的最大和最小AMA (amax和AMAmin) 均显著小于ANN组 (amax: 39 ± 8 ° vs 67 ± 15 °，p<0.001，AMAmin: 33 ± 10 ° vs 56 ± 22 °，p = 0.009)。在ANN组中观察到新LVOT直径的更严重减小 (60 ± 11% vs 26 ± 14%，p<0.001)。ANN组在植入后通过新LVOT的峰值速度较高 (200 ± 52厘米cm/s vs 108 ± 15厘米cm/s，p<0.001)。 结论: 心尖固定系统保持了较小且更稳定的主动脉瓣成角和较大的新LVOT，从而降低了该实验环境中术后新LVOT梗阻的风险。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.