肺静脉隔离联合经皮球囊二尖瓣成形术治疗风湿性二尖瓣狭窄伴长程持续性心房颤动  

Pulmonary vein isolation combined with percutaneous balloon mitral valvuloplasty for rheumatic mitral stenosis with long-standing persistent atrial fibrillation

作　　者：曹悦 张毅刚 阮宏云 李世杰 李先进 刘茹 杨浩 杜为 费亚兰 韩冰 Cao Yue;Zhang Yigang;Ruan Hongyun;Li Shijie;Li Xianjin;Liu Ru;Yang Hao;Du Wei;Fei Yalan;Han Bing(Bengbu Medical College,Center of Cardiac Diagnosis and Treatment,Xuzhou Central Hospital,Xuzhou 221009,China;Bengbu Medical College,Department of Ultrasound,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]蚌埠医学院徐州市中心医院心脏诊疗中心,221009 [2]蚌埠医学院徐州市中心医院超声科,221009

出　　处：《中华心律失常学杂志》2021年第3期212-215,共4页Chinese Journal of Cardiac Arrhythmias

基　　金：徐州市卫生健康委员会课题(徐卫科教[2017]22号)。

摘　　要：目的评估肺静脉隔离(PVI)联合经皮球囊二尖瓣成形术(PBMV)治疗风湿性二尖瓣狭窄伴长程持续性心房颤动(LSPAF)的有效性及安全性。方法入选2012年7月至2019年7月在徐州市中心医院接受PVI联合PBMV治疗的风湿性二尖瓣狭窄伴LSPAF的患者11例,其中男2例,年龄(58.2±10.0)岁,在三维电解剖系统(Carto)指导下完成PVI,以达到全部肺静脉-心房间电隔离为消融终点,然后采用球囊(Inoue)实施PBMV。比较手术前后二尖瓣瓣口面积、左心房内径、射血分数等指标,出院后通过电话及门诊随访患者症状、心电图及超声心动图检查结果等。结果所有患者均完成了PVI+PBMV手术,手术时间(189±29)min和X线曝光时间(30±10)min,术中及术后无严重并发症发生。与术前相比,术后早期超声心动图显示二尖瓣口面积明显增加[(2.13±0.13)cm^(2)对(1.19±0.13)cm^(2),P<0.001],未发现中重度二尖瓣反流。在15~72个月(中位56个月)随访中,4例患者心房颤动(房颤)复发,其中2例接受再次消融,1例在二次手术后再次复发;2例拒绝再次消融。在1~2次房颤消融术后,11例患者中8例未复发房颤。结论对于风湿性二尖瓣狭窄伴LSPAF患者,PVI联合PBMV治疗是安全可行的,对于多数患者可以取得较满意的效果。Objective To assess the effectiveness and safety of pulmonary vein isolation(PVI)combined with percutaneous balloon mitral valvuloplasty(PBMV)in patients with rheumatic mitral stenosis and long-standing persistent atrial fibrillation(LSPAF).Methods Eleven consecutive patients with rheumatic mitral stenosis and LSPAF[2 men,mean age(58.2±10.0)years old]underwent combined PVI and PBMV at Xuzhou Central Hospital between July 2012 and July 2019.PVI was performed under the guidance of three-dimensional electroanatomical system(Carto),and then use a balloon(Inoue)to implement PBMV.Mitral valve orifice area,left atrial internal diameter,and ejection fraction were compared before and after surgery.All patients were followed up by clinic visit and telephone contacts,including symptoms,electrocardiogram and echocardiography.Results In all eleven patients,combined PVI and PBMV was performed successfully with mean procedure and fluoroscopy times of(189±29)minutes and(30±10)minutes,respectively,and no serious complications occurred during and after the operation.Compared with preoperation,early postoperative echocardiography showed a significant increase in mitral valve orifice area[(2.13±0.13)cm^(2) vs.(1.19±0.13)cm^(2),P<0.001],and no moderate or severe mitral regurgitation was found.During the 15-72 months(median 56 months)follow-up,4 patients had a recurrence of atrial fibrillation,two of them underwent re-ablation with one suffering from the second recurrence,and the other refused re-intervention.Therefore,8 of 11 patients had no recurrence of atrial fibrillation.Conclusion For patients with rheumatic mitral stenosis and LSPAF,combined PVI and PMBV appeared safe and efficacious,can prevent AF recurrence in the majority of patients.

关 键 词：风湿性心脏病 二尖瓣狭窄 长程持续性心房颤动 肺静脉隔离 经皮球囊二尖瓣成形术 

分 类 号：R654.2[医药卫生—外科学]