闭式分离术后再狭窄的经皮球囊二尖瓣成形术  

Percutaneousbaloonmitralvalvuloplastyforpatientswithmitralrestenosisafterclosedmitralcom┐misurotomy

作　　者：旅朝霞[1] 方唯一[1] 于文信[1] 刘利[1] 部德秀[1] 王永忠 吕家兰[1] 金银云[1] 

机构地区：[1]大连医科大学附属第一医院心脏科

出　　处：《中华心血管病杂志》1996年第4期288-291,共4页Chinese Journal of Cardiology

摘　　要：对闭式分离术后平均１３．９±６．５（４～２４）年的１６例风湿性二尖瓣狭窄病人进行了经皮球囊二尖瓣成形术（ＰＢＭＶ）治疗。男性５例，女性１１例。平均年龄４３±６（３２～５２）岁。结果：二尖瓣口面积由０．９８±０．２０ｃｍ２增加至１．９１±０．４９ｃｍ２（Ｐ＜０．００１）；二尖瓣跨瓣压差由１．５８±１．０８ｋＰａ（１２±８ｍｍＨｇ）降至０．５０±０．５０ｋＰａ（４±４ｍｍＨｇ，Ｐ＜０．０１）。并发症：术后发生二尖瓣返流１例，返流加重１例；４例发生房间隔水平分流；３例扩张时球囊破裂。结果提示：对二尖瓣闭式分离术后再狭窄病人（１）行ＰＢＭＶ治疗是一种安全有效的方法；（２）二尖瓣超声记分对其病例选择及疗效判断有重要价值，记分≤１０者疗效最佳；（３）操作中房间隔穿刺及二尖瓣口扩张有时将面临困难，应慎重对待。Percutaneousbaloonmitralvalvuloplasty(PBMV)wasperformedin16patientswithrecurentmitralstenosis13.9±6.5(4to24)yearsafterclosedmitralcommissurotomy(CMC).Therewere5menand11womenwithameanageof43±6(32to52)years.PBMVresultedinanincreaseinmitralvalveareafrom0.98±0.20cm2to1.91±0.49cm2(P<0.01)anddecreaseinmitralvalvepresuregradientfrom1.58±1.08kPato0.50±0.50kPa(P<0.01).Complications:Newmi-tralregurgitationocuredinonepatient.Lefttorightshuntthroughtheatrialseptalpuncturesitein4patientswereshownbyDopplerechocardiography.Baloonruptureduringtheprocedurein3pa-tients.Theaboveresultsshowedthat(1)PBMVisasafeandefectiveprocedureforpatientswithrecurentmitralstenosisafterCMC.(2)Echocardiographicscoreofmitralvalvemorphologiccharac-teristicsisimportantinselectingcasesandpredictingeficacy.Thesepatientswithechocardiographicscore≤10cangetbestbenefitfromPBMV.(3)Atrialseptalpunctureandmitraldilatationsome-timesaredificult.

关 键 词：气囊扩张术 二尖瓣狭窄 闭式分离术 

分 类 号：R542.510.5[医药卫生—心血管疾病] R654.2[医药卫生—内科学]