经胸超声引导下经皮二尖瓣球囊成形术后近中期疗效评估  

Short-and mid-term outcomes of percutaneous balloon mitral valvuloplasty under the guidance of ultrasound

作　　者：孙子瑞 韩宇[1] 范太兵[1] 刘琳[1] 刘煜昊[1] 江继承 邵泽华 张戈军[2] 潘湘斌[2] Sun Zirui;Han Yu;Fan Taibing;Liu Lin;Liu Yuhao;Jiang Jicheng;Shao Zehua;Zhang Gejun;Pan Xiangbin(Structural Heart Disease Center,Henan Provincial People′s Hospital,Fuwai Hospital of Zhengzhou University,Zhengzhou 450000,China;Structural Heart Disease Center,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]河南省人民医院心脏中心郑州大学附属华中阜外医院结构性心脏病病区,郑州450000 [2]中国医学科学院北京协和医学院阜外医院国家心血管病中心结构性心脏病中心,北京100037

出　　处：《中华医学杂志》2021年第22期1690-1694,共5页National Medical Journal of China

基　　金：河南省科技厅科技攻关项目(172102310037);河南省医学科技攻关项目(201702159)。

摘　　要：目的探讨经胸超声引导下经皮二尖瓣球囊成形术(PBMV)的安全性及近中期效果。方法回顾性分析2016年12月至2019年1月在河南省人民医院经胸超声引导下PBMV患者15例临床资料,其中男9例,女6例,年龄(53±13)岁,总结术前、术后即刻效果以及术后早、中期随访结果并进行分析。结果1例患者因术后二尖瓣大量反流,转外科治疗。其余14例手术成功,术后即刻评估二尖瓣瓣口面积、左心房平均压、二尖瓣平均跨瓣压差,分别为(1.84±0.43)cm^(2)、(11.9±4.5)mmHg(1 mmHg=0.133 kPa)、(10.9±3.2)mmHg,与术前[(0.89±0.24)cm^(2)、(21.9±6.0)mmHg、(20.1±3.6)mmHg]相比差异均有统计学意义(均P<0.01);与术前相比,术后即刻三尖瓣反流面积减少[(3.79±2.81)cm^(2)比(5.26±3.99)cm^(2),P=0.03),而二尖瓣反流面积未见明显增加(P=0.67)。14例患者随访(13.8±4.6)个月,术后早、中期二尖瓣瓣口面积、N-末端脑钠肽前体(NT-ProBNP)与术前相比均改善(均P<0.01);三尖瓣反流面积较术前改善(P<0.05),二尖瓣反流未见明显变化(P>0.05);术后早期和中期比较上述各指标差异均无统计学意义(均P>0.05)。随访期间全组患者无因再狭窄二次手术者,无死亡病例。结论经胸超声引导下PBMV具有可行性和有效性,且近中期效果良好。Objective To evaluate the safety,short-and mid-term outcomes of percutaneous balloon mitral valvuloplasty(PBMV)guided by the ultrasound.Methods In this retrospective study,medical data of 15 patients[9 males and 6 females,with an age of(53±13)years]with PBMV under the guidance of ultrasound in Heart Center of Henan Provincial People′s Hospital between December 2016 and January 2019 were collected and reviewed.The short-and mid-term outcomes were analyzed.Results PBMV was successfully performed in all the patients.One patient underwent surgical valve replacement due to severe mitral regurgitation,and the other 14 patients were all followed up successfully.The average follow-up time was(13.8±4.6)months.Comparisons of preoperative and postoperative data showed significant differences in valve area[(1.84±0.43)cm^(2) vs(0.89±0.24)cm^(2)],left atrial pressure[(11.9±4.5)mmHg(1 mmHg=0.133 kPa)vs(21.9±6.0)mmHg]and mean mitral valve pressure gradient[(10.9±3.2)mmHg vs(20.1±3.6)mmHg](all P<0.01),with no significant differences in mitral regurgitation area(P=0.67).Postoperative follow-up showed that there were no significant differences in mitral valve area,regurgitation area and N-terminal pro-B-type natriuretic peptide(NT-proBNP)between short-and mid-term postoperatively(all P>0.05).There was no secondary operation due to mitral stenosis in 14 patients,and 3 patients with moderate or severe tricuspid regurgitation showed significant improvement,with gradually recovered cardiac function,and there were no deaths in these patients.Conclusion PBMV guided by the ultrasound is feasible and effective,and exhibits favorable short-and mid-term outcomes.

关 键 词：二尖瓣狭窄 超声心动描记术 球囊扩张成形术 

分 类 号：R654.2[医药卫生—外科学]