摘要目的 应用三维经食管超声心动图(3D‐TEE)评估重度主动脉瓣狭窄(AS )患者经胸主动脉瓣置换术(SAVR)与经导管主动脉瓣置入术(T AVI)后主动脉瓣 －二尖瓣联合体(AMC )的变化.方法 选取AS患者93例作为AS组,其中SAVR患者43例, TAVI患者50例;同时选取31例年龄、性别相匹配的入院行3D‐TEE检查排除血栓的患者作为对照组.测量并比较对照组及SAVR组、TAVI组术前、术后主动脉瓣、二尖瓣及AMC各参数的差异.结果 ①与对照组相比, AS组二尖瓣前后径变大,椭圆率变小,二尖瓣瓣环高度变高(均 P ＜0 .05) ;主动脉瓣开放面积变小,主动脉瓣反流面积、主动脉瓣反流流速及主动脉瓣环处内径变大(均 P ＜0 .05) ;主动脉瓣－二尖瓣夹角(AMA)及其余参数差异无统计学意义(均 P ＞0 .05) ;②与术前相比, SAVR术后,二尖瓣左右径、二尖瓣前后径、二尖瓣周长、面积变小,二尖瓣椭圆率变大(均 P ＜0 .05 ) ;主动脉瓣开放面积变大,主动脉瓣反流面积、主动脉瓣反流流速变小(均 P ＜0 .05) ; AMA及其余参数差异无统计学意义(均P＞0 .05) ;③与术前相比, TAVI术后,二尖瓣前后径、二尖瓣瓣环高度、二尖瓣周长、面积变小,二尖瓣椭圆率变大(均 P ＜0 .05) ,主动脉瓣开放面积变大,主动脉瓣反流面积、主动脉瓣反流流速及主动脉瓣环处内径变小(均 P ＜0 .05) ; AMA及其余参数差异无统计学意义(均 P ＞0 .05) .结论 重度 AS患者在SAVR 、 TAVI术后AMC在解剖和功能上发生不同程度的改变,从而证明由于AMC的存在使主动脉瓣的病变和修复均对二尖瓣产生影响,且两种术式术后患者主动脉瓣及二尖瓣形态均有不同程度恢复.

abstractsObjective To study the morphologic and functional changes of the aortic‐mitral valve coupling ( AMC) after surgical aortic valve replacement ( SAVR) or transcatheter aortic valve implantation ( T AVI ) in patients with severe aortic stenosis ( AS) using three‐dimensional transesophageal echocardiography ( 3D‐T EE) . Methods Ninty‐three severe AS patients were chosed as AS group in which 43 cases underwent SAVR and 50 cases underwent T AVI . T EE was performed before and after operation . T hirty‐one age‐and gender‐matched patients who underwent 3D‐T EE for exclusion of intracardiac thrombus were selected as control group . Cardiovascular quantitative analysis software was used to measure the parameters of aortic valve ,mitral valve and AMC in the the control group ,the SAVR group and the T AVI group before and after operation . Results ① Compared with control group ,the antero posterior ( AP ) diameter of mitral value in AS group increased ,the ellipticity of mitral valve decreased ,the height of the mitral annulus increased ( all P＜ 0 .05 ) . T he open area of aortic valve decreased ,the aortic regurgitation area ,aortic regurgitant flow velocity and the diameter of the aortic annulus increased( all P ＜0 .05) . T here was no statistical difference in aortic‐mitral valvular angle ( AM A ) and other parameters( all P ＞0 .05) . ②After SAVR ,the anterolateral‐posteromedial diameter ,AP diameter ,perimeter and area of mitral valve decreased ,the ellipticity of mitral valve increased( all P ＜0 .05) . T he aortic valve opening area increased ,the aortic regurgitation area and aortic regurgitant flow velocity decreased ( all P ＜ 0 .05 ) . T here was no statistical difference in AM A and other parameters( all P ＞0 .05) . ③After TAVI ,the AP diameter ,height , perimeter and area of mitral valve decreased ,the ellipticity of mitral valve increased ( all P ＜ 0 .05 ) . The aortic valve opening area increased ,the aortic regurgitation area ,aortic regurgitant flow velocity and the diameter of the aortic annulus decreased ( all P ＜ 0 .05 ) . T here was no statistical difference in AM A and other parameters( all P ＞0 .05) . Conclusions After SAVR and T AVI ,the anatomy and function of AMC in patients with severe AS changed to varying degrees after operation . It demonstrates that the impacts of both AS and repairment of AS on the mitral valve were . In addition ,after SAVR and T AVI ,the geometry and function of aortic and mitral valves of the patients recovered to some degrees .