Nghiên cứu đặc điểm bất tương hợp van - bệnh nhân sau thay van nhân tạo điều trị hẹp van động mạch chủ tại Bệnh viện Trung ương Quân đội 108

Mục tiêu: Nhận xét đặc điểm bất tương hợp van - bệnh nhân (Patient - prosthesis mismatch: PPM) ở bệnh nhân thay van nhân tạo điều trị hẹp van động mạch chủ (HC) và một số yếu tố liên quan. Đối tượng và phương pháp: 67 bệnh nhân được thay van động mạch chủ điều trị hẹp chủ tại Bệnh viện Trung ương Quân đội 108 trong thời gian 2010 - 2020. Nghiên cứu mô tả tiến cứu với các biến số: Tình trạng PPM và các yếu tố liên quan như bệnh kết hợp, chênh áp, NYHA và chỉ số khối cơ thất trái (LVMI). Kết quả: PPM nhẹ chiếm 1,5 – 20% trong 48 tháng theo dõi, không có PPM vừa và nặng. Các yếu tố liên quan PPM gồm nữ giới và đái tháo đường (p<0,05), tăng huyết áp, cỡ van (21 - 23), loại van sinh học không có mối liên quan (p>0,05). Chênh áp qua van tương quan chặt chẽ với PPM theo phương trình hồi qui tuyến tính bậc 2. PPM làm tăng độ suy tim theo NYHA (p<0,05) và giảm LVMI trở về bình thường sau mổ (p<0,05). Kết luận: Lựa chọn van nhân tạo phù hợp với người bệnh là rất quan trọng ảnh hưởng đến đến sự cải thiện triệu chứng và hình thái thất trái sau mổ.

Combined aortic and mitral ring enlargement in extreme patient-prosthesis mismatch

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0030-1269291 ◽

2011 ◽

Vol 59 (S 01) ◽

Author(s):

A Kowert ◽

R Schramm ◽

K Januszewska ◽

C Schmitz ◽

B Reichart ◽

...

Keyword(s):

Ring Enlargement ◽

Faculty Opinions recommendation of Aortic valve replacement with sutureless prosthesis: better than root enlargement to avoid patient-prosthesis mismatch?

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726178144.793523915 ◽

2016 ◽

Author(s):

Nawwar Al-Attar

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Better Than

Valve-in-valve transcatheter aortic valve implantation with fracturing of a failed small surgical aortic bioprosthesis: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa356 ◽

2020 ◽

Author(s):

Matjaz Bunc ◽

Miha Cercek ◽

Tomaz Podlesnikar ◽

Simon Terseglav ◽

Klemen Steblovnik

Keyword(s):

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Ex Vivo ◽

Bioprosthetic Valve ◽

Heart Team ◽

Transcatheter Aortic Valve ◽

Valve In Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Background Failure of a small surgical aortic bioprosthesis represents a challenging clinical scenario with valve-in-valve (ViV) transcatheter aortic valve implantation (TAVI) often resulting in patient-prosthesis mismatch. Bioprosthetic valve fracture (BVF) performed as a part of the ViV TAVI has recently emerged as an alternative approach with certain types of surgical bioprostheses. Case summary An 81-year-old woman with a history of three surgical aortic valve procedures presented with heart failure. Aortic bioprosthesis degeneration with severe stenosis and moderate regurgitation was found. The patient was deemed a high-risk surgical candidate and the heart team decided that ViV TAVI was the preferred treatment option. Due to the very small 19 mm stented surgical aortic bioprosthesis Mitroflow 19 mm (Sorin Group, Italy) we decided to perform BVF as a part of ViV TAVI to prevent patient-prosthesis mismatch. Since this was the first BVF procedure in our centre, an ex vivo BVF of the same kind of bioprosthetic valve was performed first. Subsequently, successful BVF with implantation of Evolut R 23 mm (Medtronic, USA) self-expandable transcatheter valve was performed. Excellent haemodynamic result was achieved and no periprocedural complications were present. The patient had an immediate major improvement in clinical status and remains asymptomatic after 6 months. Discussion Bioprosthetic valve fracture together with ViV TAVI is a safe and effective emerging technique for treatment of small surgical aortic bioprosthesis failure. Bioprosthetic valve fracture allows marked oversizing of implanted self-expandable transcatheter aortic valves, leading to excellent haemodynamic and clinical results. An ex vivo BVF can serve as an important preparatory step when introducing the new method.

Images in intervention Patient-prosthesis mismatch after mitral valve-in-valve procedure – at the cost of life or serious consequence?

Advances in Interventional Cardiology ◽

10.5114/pwki.2015.52292 ◽

2015 ◽

Vol 2 ◽

pp. 154-155

Author(s):

Dariusz Jagielak ◽

Radoslaw Kozaryn ◽

Miłosz Jaguszewski ◽

Jan Rogowski

Keyword(s):

Mitral Valve ◽

Intervention Patient ◽

Valve In Valve ◽

The Cost

Validity of identifying patient-prosthesis mismatch from the indexed effective orifice area

Journal of Artificial Organs ◽

10.1007/s10047-008-0424-5 ◽

2008 ◽

Vol 11 (3) ◽

pp. 163-164 ◽

Cited By ~ 1

Author(s):

Yoshimasa Sakamoto ◽

Kazuhiro Hashimoto ◽

Hiroshi Okuyama ◽

Shinichi Ishii ◽

Noriyasu Kawada ◽

...

Keyword(s):

Effective Orifice Area ◽

Orifice Area ◽

Patient-Prosthesis Mismatch After SAVR and TAVR

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2021.05.011 ◽

2021 ◽

Vol 14 (13) ◽

pp. 1478-1480

Author(s):

Tarun Chakravarty ◽

Moody Makar ◽

Yousif Ahmad

Keyword(s):

Patient‐prosthesis mismatch is a preventable disease but how to prevent it is a story not yet written

Journal of Cardiac Surgery ◽

10.1111/jocs.15317 ◽

2021 ◽

Vol 36 (3) ◽

pp. 978-980 ◽

Cited By ~ 1

Author(s):

Antonio M. Calafiore ◽

Antonio Totaro ◽

Stefano Guarracini ◽

Sotirios Prapas ◽

Massimo Di Marco ◽

...

Keyword(s):

Preventable Disease ◽

Patient-prosthesis mismatch in aortic valve replacement: really tolerable?

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2004.11.022 ◽

2005 ◽

Vol 27 (3) ◽

pp. 441-449 ◽

Cited By ~ 37

Author(s):

R FUSTER ◽

J MONTEROARGUDO ◽

O ALBAROVA ◽

F SOS ◽

S LOPEZ ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Abstract 6139: Flow Acceleration Time: A Novel Diagnostic Parameter for Prosthetic Aortic Valve Stenosis

Circulation ◽

10.1161/circ.118.suppl_18.s_1069-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Sagit Ben Zekry ◽

Robert M Saad ◽

Stephen H Little ◽

William A Zoghbi

Keyword(s):

Aortic Valve ◽

Characteristic Curve ◽

Effective Orifice Area ◽

List Type ◽

Ejection Time ◽

Acceleration Time ◽

Flow Acceleration ◽

Prosthetic Aortic Valve ◽

Echocardiographic Parameters

Diagnosing prosthetic aortic valve (PAV) stenosis, especially in mechanical valves, is challenging. We postulated that ejection dynamics, particularly acceleration time (AT) and the ratio of AT to ejection time (ET) can differentiate PAV stenosis from normals and those with patient-prosthesis mismatch. Doppler echocardiographic studies were reviewed and quantitated in 74 patients with PAV (38 mechanical and 36 bioprosthetic; age 61±23.6 years; valve size range). Three groups of patients were identified: patients with normal prostheses (n=60) evaluated within 3 months of surgery patients with patient-prosthesis mismatch (n=10) and documented PAV stenosis (n=14) with surgical confirmation. Quantitative Doppler parameters included ejection dynamics (AT, ET and AT/ET) and conventional PAV parameters of effective orifice area (EOA) and gradient. Summary of the Doppler parameters is presented in Table 1 . Patient with PAV stenosis had significantly lower EOA and higher gradients compared to normals and mismatch. Flow ejection parameters (ET, AT and AT/ET) were significantly longer in the stenotic valves. Patients with prosthetic mismatch, while having a normal absolute EOA, had gradients and ejection dynamics intermediate, between normal and stenotic valves. Receiver-Operating characteristic curve analysis showed that AT discriminated best PAV stenosis from normals and patients with mismatch (area under ROC=0.97). A cut off of AT = 100 msec had a sensitivity of 93% and specificity of 88% for PAV stenosis. In prosthetic aortic valves, ejection dynamics, particular acceleration time, are reliable, angle independent diagnostic parameters for identifying prosthetic valve stenosis. Table 1: Doppler Echocardiographic parameters in normal PAV, stenotic valves and patients with mismatch.