经皮二尖瓣球囊成形术98例临床观察(摘要)
作者：童雨田 马建亮 方庆欣 赵丕田
单位：山东省，潍坊市益都中心医院 心内科(262500)
关键词：
中国循环杂志99zk104 目的：对我院开展经皮二尖瓣球囊成形术(PBMV)经验总结。
方法：采用改良的Inoue法，成功的标志是舒张期杂音消失或明显减弱，跨瓣压差≤5 mmHg(1 mmHg=0.133 kPa),二尖瓣口面积至少增加25%以上，充盈状态下的球囊自行自左心室退出至左心房，无严重并发症。
结果：我院心内科自1993年10月开展PBMV以来，共做98例。平均年龄42岁。合并心房颤动46例占46.9%,合并轻度二尖瓣反流16例占16.3%,合并轻度主动脉瓣病变19例占19.4%,外科闭式分离术史者16例占16.3%,晚期妊娠1例占1.02%。98例除1例因瓣口面积过小(0.45 cm2)未成功外，其余97例均获成功。出现并发症者5例，其中心包填塞2例，脑栓塞3例。2例心包填塞患者经心包引流后缓解。3例脑栓塞患者症状出现后20分钟内静脉注射尿激酶20万单位，1小时内肌力逐渐恢复。二尖瓣反流加重4例，患者血液动力学状况均未见恶化，本组无死亡病例发生。
, http://www.100md.com
结论：①瓣口面积0.5 cm2患者，如果瓣膜状况相对较好也多能成功。②年龄大于60岁，如瓣膜条件好效果仍满意。③性能良好的经胸彩色超声心动图对发现左心房血栓仍有很高的可信度。④妊娠患者的PBMV通常接受放射剂量为0.005 GY,因此对孕妇及胎儿是安全的。⑤股静脉穿刺点在腹股沟皱折处进球囊导管较容易。⑥心房间隔穿刺成功的标志有时需要左心房造影，如果造影剂在局部点状不散则提示针尖在心房间隔肌层内，如果造影剂缓慢散开，则提示已穿破房壁。⑦球囊导管尽量不使用反C字型进入左心室，否则容易招致血栓脱落或左心房穿孔。⑧二尖瓣扩张采取顺序多次渐进法以避免严重的二尖瓣反流这一常见并发症的发生。
Clinical Observation of 98 Cases of Percutaneous Balloon Mital Valvuloplasty (Abstract)
Department of Cardiology, Yidu Central Hospital, Weifang (262500), Shangdong
, 百拇医药
Tong Yutian, Ma Jianliang, Fang Qingxin, et al.
Objective: To summarize our experience in percutaneous balloon mital valvuloplasty (PBMV).
Methods: Improved Inoue was applied. It was considered successful that the diastolic murmur disappeared or apparently reduced, the pressure gradient across the mitral valve ≤5 mmHg, the area of mitral orifice increased at least over 25%, and the filled balloon automatically withdrew from left ventricle to left atrium, with no serious complication.
, 百拇医药
Results: Since the Department of Cardiology of this hospital began the technique of percutaneous balloon mitral valvuloplasty (PBMV) in October 1993, we have performed 98 cases with an average age of 42. Among them 46 cases had concurrent atrial fibrillation (46.9%), 16 had concurrent slight mitral insufficiency (16.3%), 19 cases had slight pathological changes of concurrent aortic valve (19.4%), 16 cases had the history of closed surgical separation (16.3%), and one with late pregnancy (1.02%). All cases were successful except one with excessive insufficient of the area of mitral orifice (less than 0.45 cm2). Five had complications, among them 2 of pericardial tamponade and 3 with cerebral embolism. After pericardial drainage. The two cases of pericardial tamponade relieved. For the three cases of cerebral embolism, intravenous injection of 200 000 units of urokinase was performed 20 minutes after the appearance of the symptom, and the myodynamia gradually recovered within one hour. For the four cases of worsened mitral insufficiency, no deterioration was found in terms of hemodynamics. No deaths occurred in this group.
, 百拇医药
Conclusions: ① Most of the patients whose mitral orifice area is 0.5 cm2, and whose valves are fairly good, are likely to be successful. ② For those over 60 years old but with good valves, the results will still be satisfactory. ③ Good-quality chest color ultrasonograph has high reliabilty in discovering left auricular thrombi. ④ For patients of pregnancy and the fetus, the PBMV is safe, because the usual radiological dose is low (0.005 GY). ⑤ It is easier to enter the balloon catheter with venipuncture point at the rugosity of inguinal region. ⑥ Contrast image of left atrium is sometimes needed in presentation of the signs of success in atrial septum puncture. The fact that the contrast medium remains undispersed at a local spot indicates that the needle point remains in muscular layer of the atrial septum, whereas slow dispersion of the contrast medium indicates that the needle point has pierced through the atrial wall. ⑦ C-shaped entering pattern should be avoided while the balloon catheter enters the left ventricle, otherwise it will result in thrombus exfoliation or perfortion of left atrium. ⑧ Sequence repeated progressive method is recommendable in mitral dilatation in order to avoid severe mitral insufficiency, the common complication., http://www.100md.com
单位：山东省，潍坊市益都中心医院 心内科(262500)
关键词：
中国循环杂志99zk104 目的：对我院开展经皮二尖瓣球囊成形术(PBMV)经验总结。
方法：采用改良的Inoue法，成功的标志是舒张期杂音消失或明显减弱，跨瓣压差≤5 mmHg(1 mmHg=0.133 kPa),二尖瓣口面积至少增加25%以上，充盈状态下的球囊自行自左心室退出至左心房，无严重并发症。
结果：我院心内科自1993年10月开展PBMV以来，共做98例。平均年龄42岁。合并心房颤动46例占46.9%,合并轻度二尖瓣反流16例占16.3%,合并轻度主动脉瓣病变19例占19.4%,外科闭式分离术史者16例占16.3%,晚期妊娠1例占1.02%。98例除1例因瓣口面积过小(0.45 cm2)未成功外，其余97例均获成功。出现并发症者5例，其中心包填塞2例，脑栓塞3例。2例心包填塞患者经心包引流后缓解。3例脑栓塞患者症状出现后20分钟内静脉注射尿激酶20万单位，1小时内肌力逐渐恢复。二尖瓣反流加重4例，患者血液动力学状况均未见恶化，本组无死亡病例发生。
, http://www.100md.com
结论：①瓣口面积0.5 cm2患者，如果瓣膜状况相对较好也多能成功。②年龄大于60岁，如瓣膜条件好效果仍满意。③性能良好的经胸彩色超声心动图对发现左心房血栓仍有很高的可信度。④妊娠患者的PBMV通常接受放射剂量为0.005 GY,因此对孕妇及胎儿是安全的。⑤股静脉穿刺点在腹股沟皱折处进球囊导管较容易。⑥心房间隔穿刺成功的标志有时需要左心房造影，如果造影剂在局部点状不散则提示针尖在心房间隔肌层内，如果造影剂缓慢散开，则提示已穿破房壁。⑦球囊导管尽量不使用反C字型进入左心室，否则容易招致血栓脱落或左心房穿孔。⑧二尖瓣扩张采取顺序多次渐进法以避免严重的二尖瓣反流这一常见并发症的发生。
Clinical Observation of 98 Cases of Percutaneous Balloon Mital Valvuloplasty (Abstract)
Department of Cardiology, Yidu Central Hospital, Weifang (262500), Shangdong
, 百拇医药
Tong Yutian, Ma Jianliang, Fang Qingxin, et al.
Objective: To summarize our experience in percutaneous balloon mital valvuloplasty (PBMV).
Methods: Improved Inoue was applied. It was considered successful that the diastolic murmur disappeared or apparently reduced, the pressure gradient across the mitral valve ≤5 mmHg, the area of mitral orifice increased at least over 25%, and the filled balloon automatically withdrew from left ventricle to left atrium, with no serious complication.
, 百拇医药
Results: Since the Department of Cardiology of this hospital began the technique of percutaneous balloon mitral valvuloplasty (PBMV) in October 1993, we have performed 98 cases with an average age of 42. Among them 46 cases had concurrent atrial fibrillation (46.9%), 16 had concurrent slight mitral insufficiency (16.3%), 19 cases had slight pathological changes of concurrent aortic valve (19.4%), 16 cases had the history of closed surgical separation (16.3%), and one with late pregnancy (1.02%). All cases were successful except one with excessive insufficient of the area of mitral orifice (less than 0.45 cm2). Five had complications, among them 2 of pericardial tamponade and 3 with cerebral embolism. After pericardial drainage. The two cases of pericardial tamponade relieved. For the three cases of cerebral embolism, intravenous injection of 200 000 units of urokinase was performed 20 minutes after the appearance of the symptom, and the myodynamia gradually recovered within one hour. For the four cases of worsened mitral insufficiency, no deterioration was found in terms of hemodynamics. No deaths occurred in this group.
, 百拇医药
Conclusions: ① Most of the patients whose mitral orifice area is 0.5 cm2, and whose valves are fairly good, are likely to be successful. ② For those over 60 years old but with good valves, the results will still be satisfactory. ③ Good-quality chest color ultrasonograph has high reliabilty in discovering left auricular thrombi. ④ For patients of pregnancy and the fetus, the PBMV is safe, because the usual radiological dose is low (0.005 GY). ⑤ It is easier to enter the balloon catheter with venipuncture point at the rugosity of inguinal region. ⑥ Contrast image of left atrium is sometimes needed in presentation of the signs of success in atrial septum puncture. The fact that the contrast medium remains undispersed at a local spot indicates that the needle point remains in muscular layer of the atrial septum, whereas slow dispersion of the contrast medium indicates that the needle point has pierced through the atrial wall. ⑦ C-shaped entering pattern should be avoided while the balloon catheter enters the left ventricle, otherwise it will result in thrombus exfoliation or perfortion of left atrium. ⑧ Sequence repeated progressive method is recommendable in mitral dilatation in order to avoid severe mitral insufficiency, the common complication., http://www.100md.com