经皮二尖瓣球囊扩张术治疗二尖瓣狭窄伴中度返流  

Percutaneous balloon mitral valvuloplasty for mitral stenosis with moderate mitral regurgitation

作　　者：李华泰[1] 尹秋林[1] 洪浪[1] 曹平良[1] 魏云峰[1] 洪明[1] 

机构地区：[1]江西省人民医院心内科,南昌330006

出　　处：《中国介入心脏病学杂志》2004年第1期18-20,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的　探讨经皮二尖瓣球囊扩张术 (PBMV)治疗二尖瓣狭窄 (MS)伴中度二尖瓣返流(MR)的近、远期疗效。方法　采用自制二尖瓣球囊导管治疗MS伴中度MR患者 6 2例 ,其中二尖瓣膜明显增厚、钙化者 7例 ,对左室最大前后径、二尖瓣口面积、左房平均压、二尖瓣跨瓣压差及心功能(NYHA分级 )等主要指标随访观察 12～ 36个月。结果　术后二尖瓣口面积明显增大 [(0 83± 0 18)cm2 比 (1 86± 0 2 4 )cm2 ,P <0 0 1],左房平均压 [(32± 8)mmHg比 (13± 8)mmHg ,P <0 0 1,1mmHg=0 133kPa]及二尖瓣跨瓣压差 [(18± 9)mmHg比 (5± 3)mmHg ,P <0 0 1]明显降低 ,心功能明显改善 [(2 81± 0 2 4 )级比 (1 4 6± 0 37)级 ,P <0 0 1],左室最大前后径无显著改变 [(4 5± 4 )mm比 (4 6± 4 )mm ,P >0 0 5 ]。对左室最大前后径、二尖瓣口面积及心功能等指标随访观察 12～ 36个月均无明显改变。结论　选择合适病例 ,严格把握球囊扩张终点 ,风湿性二尖瓣狭窄并中度返流患者PBMV的近、远期疗效显著。Objective To evaluate the effects of percutaneous balloon mitral valvotomy (PBMV) for mitral stenosis (MS) with moderate mitral regurgitation (MR), particularly with bad mitral condition. Methods PBMV was performed in 62 patients with both MS and MR, of whom 7 had bad mitral condition, and the changes of mitral valve area, mean left atrial pressure , mitral valve gradient, cardiac function and left ventricular maximal diameter were observed. Results Mitral valve area increased from (0.83±0.18) cm 2 to (1.86±0.24) cm 2 (P<0.01), while mean left atrial pressure decreased from (32±8) mm?Hg to (13±8) mm?Hg (P<0.01), and mitral valve gradient decreased from (18±9) mm?Hg to (5±3) mm?Hg (P<0.01); cardiac function (NYHA class) had also been improved [from (2.81±0.24) to (1.46±0.37), P<0.01], but left ventricular maximal diameter had no significant difference [(45±4) vs (46±4), P<0.05]. Some main parameters, including left ventricular maximal diameter, mitral valve area and cardiac function didn′t show further difference in the 12 to 36 months′ follow-up. Conclusion The results demonstrated that PBMV is an effective and reliable procedure in the treatment of MS with moderate MR, but its prerequisites are mastery of patients′selection criterion, skilled manipulating, and strict control of dilation degree.

关 键 词：经皮二尖瓣球囊扩张术 二尖瓣狭窄 二尖瓣返流 心功能 彩色多普勒超声 血流动力学 

分 类 号：R654.2[医药卫生—外科学]