单纯超声心动图引导下经皮二尖瓣球囊成形术的可行性及有效性研究  

Feasibility and Effectiveness of Percutaneous Balloon Mitral Valvuloplasty Under Echocardiographic Guidance Only

作　　者：王城 欧阳文斌[1] 张凤文[1] 郭改丽[1] 刘垚 赵广智[1] 谢涌泉[1] 潘湘斌[1] WANG Cheng;OUYANG Wen-bin;ZHANG Feng-wen;GUO Gai-li;LIU Yao;ZHAO Guang-zhi;XIE Yong-quan;PAN Xiang-bin(Department of Cardiac Surgery,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing（100037）,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心外科,北京市100037

出　　处：《中国循环杂志》2018年第11期1080-1084,共5页Chinese Circulation Journal

基　　金：中国医学科学院医学与健康科技创新工程(2017-12M-4-001);北京市青年拔尖团队项目(2015000021223TD05)

摘　　要：目的:评估单纯超声心动图引导下经皮二尖瓣球囊成形术(PBMV)的可行性。方法:对2016-10至2017-10间在本中心以单纯超声心动图引导下PBMV治疗风湿性重度二尖瓣狭窄的24例患者进行分析。所有患者于术后1、3、6及12个月门诊随访,行X线胸片、心电图和经胸超声心动图检查。结果:24例患者均在单纯超声心动图引导下成功施行了PBMV。术后经导管测二尖瓣跨瓣压差由(15.0±5.1)mm Hg(1 mmHg=0.133 kPa)降到了(6.7±2.9)mmHg(P<0.01),超声心动图检测二尖瓣瓣口面积由(0.8±0.1)cm2增加到了(1.7±0.1) cm2(P<0.01)。平均球囊直径为(26.7±1.2)mm。其中有8例患者术后出现二尖瓣轻度反流。平均随访时间为(7.4±3.1)个月。最后一次随访时,二尖瓣瓣口面积仍高达(1.6±0.1) cm^2,平均二尖瓣跨瓣压差为(9.0±4.3) mmHg。本组所有患者术后未出现心包积液或外周血管并发症。结论:单纯超声心动图引导下可以成功施行PBMV,其在避免了X线辐射及对比剂使用下仍然具有较高的安全性及有效性。Objectives： The present first-in-human study aimed to assess the feasibility of percutaneous balloon mitral valvuloplasty（PBMV） for the treatment of isolated mitral stenosis（MS） under echocardiography guidance only. Methods： Data were obtained from 24 consecutive patients with severe MS, who underwent PBMV from October 2016 to October 2017 under the guidance of echocardiography only. Outpatient follow-up including chest radiography, electrocardiography, and transthoracic echocardiography was conducted at 1, 3, 6 and 12 months post procedure. Results： PBMV was successful in all 24 patients under echocardiography guidance without radiation and contrast agent. Mitral transvalvular pressure gradient derived invasive catheterization measurement dropped from（15.0±5.1） mmHg to（6.7±2.9） mmHg（P〈0.01）. Mitral valve area increased from（0.8±0.1） cm2 at pre-PBMV to（1.7±0.1） cm2 post-PBMV（P〈0.01）. Mean balloon diameter was（26.7±1.2） mm. Mild mitral regurgitation developed in 8 patients. Mean follow-up duration was（7.4±3.1） months. At the last follow-up, mitral valve area remained high（1.6±0.1） cm^2 and mean transmitral pressure gradient remained low（9.0±4.3） mmHg. No pericardial effusion or peripheral vascular complications occurred. Conclusions： In this patient cohort, PBMV could be successfully performed with echocardiography as the single imaging guidance modality, this procedure is safe and effective and avoids the radiation exposure and contrast agent use.

关 键 词：风湿性二尖瓣狭窄 二尖瓣球囊成形术 超声心动图 经皮介入 

分 类 号：R541[医药卫生—心血管疾病]