经皮穿刺二尖瓣球囊成形术(PBMV)100例经验体会  

Percutaneous Balloon Mitral Valvuloplasly: The experience of 100 Patients

作　　者：方唯一[1] 于文信[1] 旅朝霞[1] 李新明[1] 部德秀 徐文林[2] 李贵海 于军 

机构地区：[1]大连医学院附属第一医院心脏科,116011 [2]大连医学院附属第一医院超声诊断科 [3]大连医学院附属第一医院放射科

出　　处：《中国介入心脏病学杂志》1993年第3期12-15,49,共5页Chinese Journal of Interventional Cardiology

摘　　要：我院采用Inoue单球囊法对100例风心病二尖瓣狭窄患者施行了PBMV治疗.患者中24例合并有轻度二尖瓣关闭不全,16例有轻度主动脉狭窄或关闭不全.术后患者血液动力学显著改善:左心房压从25.3±8.8降到12.4±6.3mmHg,跨二尖瓣压差17.1±7.1降至3.5±3.4mmHg,二尖瓣口面积从1.04±0.26扩大到2.08±0.32cm^2,心功能从2.8±0.5提高到1.3±0.5级.96%病例有双侧或单侧融合的二尖瓣双界被裂开.主要并发症有急性心包填塞(4例),严重二尖瓣返流(6例)和房间隔分流(4例).心包填塞主要是房间隔穿刺失误所致,严重二尖瓣返流多发生在瓣膜和融合的交界有明显钙化以及瓣下结构融合的病例,房间隔分流多为 二尖瓣扩张不理想所致.对于二尖瓣结构较好的患者,PBMV并不明显加重其原已存在的二尖瓣返流和主动脉瓣轻度病变.因此,掌握好房间隔穿刺技术、有效降低左心房压和选择好无明显瓣膜(尤其是瓣交界)钙化和瓣下严重融合的病例,是PBMV成功和减少严重并发症发生的重要保证.The operation of percuutaneous balloon mitral valvuloplasty ( PBMV ) was performed with Inoue bal-loon on 100 patients with rhumatic mitral stenosis. Ex-cepting the mitral stenosis for these patients, 24 cases had a mild mitral regurgitation and 16 cases had a mild damage of aortic valve. The changes of mitral morphol-ogy were com-paratively analysed by echocardiography before and 3 days ofter PBMV. Most patients had a sig-nificante improvement of hemodynamics after the proc-cedure:the left atrial pressurewas decreased from 25. 3 ±8. 8 to 12. 4 ±6. 3 mmHg,transmitral pressure gra-dient was deccreased from 17. 7±7. 1 to 3. 5 ±3. 4 mmHg,mitral valve area was increased from 1. 04 ±0. 26 to 2. 08±0. 32cm2,and left atrial diameter was re-duced from 44. 5±8. 5 to 37. 1 ±6. 4mm. CCardiac function was raised from 2. 8 ±0. 5 to 1. 3 ±0. 5 de-gree (p<0. 05). 96% patients had addouble or single side slit of their fusion commissure. The complications were ccardiac tam-ponade(4 cases), severe mitral re-gurgitation (6 cases)and marked atrial seotal shunt(?)4 cases). The inex-perience of septal puncture at early stage of our works was responsible for the occurence of cardiac tamponade, the incidence of mitral regurgitation induced by PBMV was related to the degree of the leaflet or the commissural calcification and the suub-valvular extensive fusion, and insufficient decrease of left atrial pressure was main reason of atrial septal shunt. For patients with mild mitral regurgitation and mild damage of aortic valve, PBMV can also be per-formed on them.

关 键 词：二尖瓣球囊成形术 心包填塞 二尖瓣返流 

分 类 号：R541[医药卫生—心血管疾病]