二尖瓣口短暂球囊充盈对左心耳云雾状影和流速的影响  

The Effect of Transient Balloon Occlusion of the Mitral Orifice on Left Atrial Appendage Blood Flow Velocity and Spontaneous Echo Contrast

作　　者：王建安[1] 张湘兰[1] 杨倩[1] 冼棠超[1] 鲁端[1] 单江[1] 

机构地区：[1]杭州市浙江大学医学院附属邵逸夫医院心内科,310016

出　　处：《中国超声医学杂志》2000年第2期112-115,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的： 观察经皮二尖瓣球囊扩张术（ＰＢＭＶ） 中， 球囊充盈和排空对左心耳云雾影（ＳＥＣ） 现象和左心耳流速的影响。方法： 对３５例符合ＰＢＭＶ适应征的风心病二尖瓣狭窄患者， 行术中ＴＥＥ检查， 采用长轴二腔心并充分显示左心耳的平面。共充盈球囊１２３ 次， 其中用于观察左心耳ＳＥＣ的６１次， 平均充盈时间４．６±１．１秒； 测定左心耳流速的６２次， 平均充盈时间４．５±１．３秒。结果： 球囊充盈时ＳＥＣ增强或新出现者占６１次中的５３次， 无明显改变的８ 次； 球囊排空后， 和球囊充盈时比较， 无明显改变的６次， 程度减轻３７次， 完全消失１８ 次。球囊充盈时， 左心耳最大充盈流速（ＭＦＶ） 和最大排空流速（ＭＥＶ） 显著低于球囊充盈前和排空后， Ｐ均＜ ０．００１。结论： 二尖瓣口球囊充盈时左心耳ＳＥＣ显著增强和左心耳流速的显著减低， 直接反映左心耳ＳＥＣ现象是左心房和左心耳血流高度淤滞的结果， 和二尖瓣口面积显著缩小有关， 是一种动力性的和可复性的变化。同时提示， ＰＢＭＶ术中可能促进左心房及左心耳血栓形成和血栓栓塞。Objective:To report the effect of transient occlusion of the mitral orifice on atrial appendage blood flow velocity and spontaneous echo contrast(SEC)of human heart using intraoperative transesophageal echocardiography(ITE).Methods:Thirty five patients with rheumatic mitral stenosis underwent percutaneous balloon mitral valvotomy monitered by intraoperative transesophageal echocardiography Alternative measurement of left atrial appendage velocities and observvation of the left atrium various grades spontaneous echo contrast(0=none to 4=severe)before and after each balloon inflation were performed.Results:Left atrial appendage maximal ejection velocity(LAA MEV)was reduced from 35±14mm/s to 6±2 mm/s at peak balloon inflation and increased to 40±16 mm/s after balloon deflation.In comparison with the values before balloon inflation and after balloon deflation,the LAA velocities were significantly lowered ( P <0 001).New or increased SEC grade was observed during 54 of 61(88%)inflations and unchanged in 7(12%)inflations at peak balloon inflation.SEC became lower in grade after 55 balloon deflations(90%),completely disappeared after 18 deflations(30%)and remained unchanged after 6 deflations(10%).The mean time to achieve maximal SEC grade(2 5±1 2 seconds)correlated with the mean time to trough LAA velocities(2 3±1 1 seconds)after balloon inflation.Upon deflation,the mean time to lowest SEC grade(2 9±1 8 seconds)correlated with mean time to achieve maximal LAA velocities(2 7±1 6 seconds).Conclusion:Reducing the velocity of blood flow in the human left atrium by balloon occlusion of the mitral valve enhances SEC whereas restoring blood flow after balloon deflation would cause the enhanced echogenic blood disappeared or lightened.

关 键 词：二尖瓣狭窄 球囊成形术 PBMV 左心耳云雾状 

分 类 号：R654.2[医药卫生—外科学]