风湿性二尖瓣狭窄合并三尖瓣关闭不全患者行PBMV的临床研究  

Clinic Study of Percutaneous Balloon Mitral Valvuloplasty in Patients with Rheumatic Mitral Stenosis and Tricuspid Incompetence

作　　者：周裔忠[1] 盛国太[1] 李华泰[1] 洪明[1] 

机构地区：[1]江西省人民医院心内科1科,330006

出　　处：《临床放射学杂志》2014年第3期426-429,共4页Journal of Clinical Radiology

摘　　要：目的探讨Inoue法经皮球囊二尖瓣成形术(PBMV)对风湿性二尖瓣狭窄(有或无二尖瓣关闭不全)合并三尖瓣关闭不全患者疗效。方法本院自2007年1月至2012年12月164例风湿性二尖瓣狭窄(有或无二尖瓣关闭不全)合并三尖瓣关闭不全患者接受PBMV,心导管测定患者PBMV前后的左右心房压力,心脏超声评价PBMV前后二尖瓣口面积、二尖瓣口血流速度、二尖瓣反流面积、三尖瓣反流面积及左房内径、左室舒张末径、右房内径、右室舒张末径、每搏输出量及超声估测的肺动脉压(ePAP)等指标。结果 PBMV成功率100%,无围手术期并发症及死亡病例,无需要急诊外科干预病例。同扩张前相比,右房平均压力扩张后无明显改变,左房平均压术前(24.4±2.12)mmHg,术后(15.4±2.01)mmHg(P<0.05)。二尖瓣瓣口面积:术前(0.92±0.28)cm2,术后第2天(1.88±0.32)cm2(P<0.05),术后第6个月(2.02±0.12)cm2,术后第12个月(1.94±0.24)cm2;二尖瓣口血流速度:术前(2.87±0.34)m/s,术后第2天(1.27±0.36)m/s,术后第6个月(1.24±0.23)m/s,术后第12个月(1.21±0.28)m/s。二尖瓣反流面积、三尖瓣反流面积在术后有所下降,但无显著差异。左房内径:术前(56.4±3.1)mm,术后第2天(52.6±2.84)mm,术后第6个月(46.6±2.49)mm,术后第12个月(43.2±2.68)mm;左室舒张末径:术前(39.36±5.62)mm,术后第2天(38.78±5.43)mm,术后第6个月(43.22±6.16)mm,术后第12个月(46.4±6.38)mm。右房内径:术前(46.4±3.2)mm,术后第2天(44.6±2.92)mm,术后第6个月(36.28±6.48)mm,术后第12个月(33.2±5.32)mm。右室舒张末径:术前(38.42±6.14)mm,术后第2天(36.24±4.68)mm,术后第6个月(32.46±5.64)mm,术后第12个月(28.3±5.28)mm。每搏输出量:术前(57.12±6.28)ml,术后第2天(60.22±5.24)ml,术后第6个月(63.22±4.82)ml,术后第12个月(68.2±4.4)ml。ePAP:术前(78.6±8.2)mmHg,术后第2天(63.2±6.1)mmHg,术后第6个月(55.8±7.4)mmHg,术后第12个月(43.2±5.8)mmHg。结论 PBMV治疗风湿性二尖瓣狭窄�Objective To assess the efficacy and safety of percutaneous balloon mitral valvuloplasty （PBMV） using the inoue balloon in 164 cases with rheumatic mitral stenosis （with/or no mitral incompetence） and tricuspid incompetence. Methods Right atrial pressure and left atrial pressure were measured during PBMV process,all patients were followed up for 1 year after PBMV. Mitral valve mitral area, valve blood velocity, mitral regurgitation area and tricuspid regurgitation area were detected by cardiac echocardiography. Meanwhile,the left atrial diamater（LAD） ,left ventricular end diastolic diameter（ LVEDD）, reft atrial diamater（ RAD）, left ventricular end diastolic diameter（ RVEDD）, stroke volume （SV）, the estimated pulmonary artery pressure （ePAP） were also detected by cardiac echocardiography. Results The success rate of PBMV was 100 percent, no death and no serious complications were occurred during the process, no changes was found in right atrial pressure before and after PBMV. left atrial pressure were （24.4±2.12） mmHg and（ 15.4±2.01 ）mmHg before and after PBMV respectively （P 〈 0.05 ）. Compared with the preoperative, mitral valve mitral area, valve blood velocity were decreased（ all P 〈 0.05 ） , no changes were found in mitral regurgitation area and tricuspid regurgitation area before and after PBMV. Compared with the preoperative, LAD, LVEDD, RAD, RVEDD, SV ePAP were changed after the PB-MV （ all P 〈 0.05）. Conclusion PBMV is an effective, safe treatment for mitral stenosis （ with/or no mitral incompetence） and tricuspid incompetence.

关 键 词：风湿性二 尖瓣狭窄 二尖瓣关闭不全 三尖瓣关闭不全 经皮球囊二尖瓣成形术 

分 类 号：R541.2[医药卫生—心血管疾病]