Clinical Analysis and Echocardiographic Evaluation of Paravalvular Leaks After Surgical Aortic Valve Replacement
10.3969/j.issn.1000-3614.2018.05.016
- VernacularTitle:主动脉瓣置换术后瓣周漏的临床及超声心动图分析
- Author:
Xing ZHAO
1
;
Hao WANG
;
Yi-Ming GAO
;
Si-Qi LIU
;
Min SONG
;
Jian-Ping XU
Author Information
1. 中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院 超声科
- Keywords:
Paravalvular leaks;
Aortic valve replacement;
Echocardiography
- From:
Chinese Circulation Journal
2018;33(5):485-489
- CountryChina
- Language:Chinese
-
Abstract:
Objectives: To explore the clinical features and the value of echocardiographic examination of paravalvular leaks after surgical aortic valve replacement. Methods: A total of 123 patients (aged from 12-74 [mean age 45 ± 13] years) hospitalized in our hospital from 2002-03 to 2017-03 because of paravalvular leaks after surgical aortic valve replacement were included in this study. The first operation was performed in our hospital or other hospitals. All patients had a confirmed diagnosis of paravalvular leaks by transthoracic or transesophageal echocardiography. Among them, 28 cases received non-surgical treatment and paravalvular leaks were corrected by reoperation in 95 cases. Results: Diastolic paravalvular regurgitation was detected by color doppler echocardiography in most patients, and dehiscence between the artificial valve and adjacent tissue was evidenced by two-dimensional echocardiography in some patients. The causes of paravalvular leaks, defined by imaging modalities including echocardiography, operative findings and pathological results included: infective endocarditis in 45 patients, Bechet's syndrome in 23 patients, Takayasu arteritis in 4 patients, suspected diagnosis of immune system diseases in 5 patients, aortic dissection in 2 patients, suspected operative technical reasons in 3 patients, and unknown in 41 patients. There were 13 deaths in this cohort, 5 patients gave up the further treatment and self-discharged due to the serious disease conditions. During follow-up, mild degree or above paravalvular leaks were found in 27 patients, 1 patient suffered from heart failure, improvement or recovery were seen in 55 patients.Conclusions: The paravalvular leaks with significant clinical consequence is an important complication after surgical aortic valve replacement, and most patients need to be treated with reoperation. Despite reoperation, the recurrence rate remains high and the prognosis is poor. Infective endocarditis is the most common cause of paravalvular leaks in prosthetic aortic valves, followed by non-specific vasculitis. Echocardiography plays an important role on diagnosis and monitoring in these patients.
