Transesophageal echocardiographic evaluation of tricuspid valve regurgitation during pacemaker and implantable cardioverter defibrillator lead extraction
Transesophageal echocardiographic evaluation of tricuspid valve regurgitation during pacemaker and implantable cardioverter defibrillator lead extraction
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DOI：
10.1046/j.1460-9592.2002.01583.x
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发表时间：
2002-11-01
影响因子：
1.8
通讯作者：
Peels, K
中科院分区：
文献类型：
--
作者：
Roeffel, S;Bracke, F;Peels, K
长期植入的心脏起搏和除颤器(ICD)导线可以附着在三尖瓣上。本研究检测了铅提取，尤其是失败者鞘提取对三尖瓣返流的影响。铅的提取首先尝试用有限的力量牵引，如果不成功，则使用激光护套。采用经食道超声心动图评价拔除前后的三尖瓣返流情况，按0分(无)至4分(重度)。反流的改变被认为是临床相关的，如果它增加了两级或更多，并导致至少3级反流。43例患者共拔除50个室性导联，其中ICD导联14个。20例患者(I组)在没有穿过三尖瓣(激光)鞘的情况下拔除导联，23例(II组)通过瓣膜激光拔除导联。平均植入时间分别为43+/-43个月和99+/-78个月(P=0.007)。三尖瓣反流增加5例(12%)。在第一组中，只有一名患者的激光在瓣膜近端失败，随后使用了强力牵引，而在第二组中，这发生在四名患者(17%)。即使将患者排除在I组之外，这一差异也没有达到统计学意义(P=0.111)。三尖瓣返流的增加告诫不要不加选择地取出多余的导联。有一种趋势是，当需要像激光护套这样的工具时，三尖瓣损伤的机会增加。
Chronically implanted ventricular pacing and defibrillator (ICD) leads can adhere to the tricuspid valve. This study examined the effect of lead extraction, and loser sheath extraction in particular, on tricuspid valve regurgitation. Lead extraction was first tried with traction using limited force followed by a laser sheath if not successful. Tricuspid valve regurgitation before and after extraction was evaluated with transesophageal echocardiography and graded from 0 (none) to 4 (severe). A change in regurgitation was considered clinically relevant if it increased with two grades or more and resulted in at least grade 3 regurgitation. Fifty ventricular leads were extracted in 43 consecutive patients, including 14 ICD leads. In 20 patients (group I) leads were removed without a (laser) sheath crossing the tricuspid valve, in 23 patients (group II) leads were extracted with lasing across the valve. The mean time from implant was 43 +/- 43 months and 99 +/- 78 months, respectively, (P = 0.007). Tricuspid regurgitation increased in five (12 %) patients. In group I only in one patient the laser failed proximal of the valve and forceful traction was subsequently used, and in group II this occurred in four (17%) patients. This difference did not reach statistical significance even excluding the patient from group I (P = 0.111). The increase of tricuspid regurgitation cautions against indiscriminate extraction of superfluous leads. There is a trend that when tools like a laser sheath are necessary the chance of tricuspid valve damage increases.