经皮二尖瓣球囊成形术24例临床分析(摘要)
作者：马小川 王建清 王东琦 付文
单位：：陕西省延安市，延安大学医学院附属医院(710061) 马小川 王建清；陕西省西安市，西安医科大学第一附属医院 王东琦 付 文
关键词：
目的 目的：评价经皮二尖瓣球囊成形术(PBMV)在治疗二尖瓣狭窄中的作用。
方法：采用改良Inoue单球囊技术对24例风湿性二尖瓣狭窄患者行PBMV。24例(男6例，女18例)，年龄35.5±7.6岁，病程6.0±4.5年，无风湿热活动。超声心动图明确诊断，二尖瓣口面积(MVA)1.04±0.27 cm2,无心房附壁血栓。NYHA心功能Ⅱ～Ⅲ级。其中伴轻度主动脉瓣关闭不全5例，轻度二尖瓣关闭不全4例，心房颤动7例。所有患者采用右股静脉通路。先行右心导管测定肺动脉压，右心室压力。定位卵圆窝，后前位透视下穿刺心房间隔，肝素化。送左心房导引钢丝入左心房，沿此钢丝送球囊导管进入左心室，充盈前半球囊，同时回撤球囊导管恰嵌在狭窄的二尖瓣口，迅速充盈二尖瓣球囊，扩张瓣口，至腰部凹形消失，立即抽空球囊。依据身高cm÷10+10 mm选择球囊直径。依据二尖瓣跨瓣压力阶差(MVPG)、左心房压力(LAP)、心音听诊来决定扩张的次数。统计学方法用均数±标准差，t检验。
, 百拇医药
结果：术后血液动力学显著改善。LAP从3.45±1.12 kPa降至1.60±0.80 kPa(P<0.01),MVPG从2.6±0.34 kPa降至0.41±0.19 kPa(P<0.01),MVA从1.04±0.27 cm2扩大至2.12±0.23 cm2(P<0.01)。1例心房间隔穿刺未成功。1例术中发生快速心房颤动，直流同步电复律恢复窦性心律后完成了手术。无一例发生心包填塞、严重二尖瓣关闭不全、栓塞或心室颤动等严重并发症。
结论：PBMV后MVA增加。结果亦提示，只要术前准备充分，术中仔细操作，PBMV已成为治疗风湿性二尖瓣狭窄安全有效的方法。
Clinical Analysis of the Percutaneous Balloon Mitral Valvuloplasty in 24 Cases (Abstract)
The Affiliated Hospital of Medical College of Yan′an University, Yan′an (716000), Shaanxi
, 百拇医药
Ma Xiaochuan, Wang Jianqing, Wang Dongqi, et al.
Objective: To evaluate the effect of percutaneous balloon mitral valvuloplasty (PBMV) on rheumatic mitral stenosis (MS).
Methods: The operation of PBMV was performed with improved Inoue technique in 24 patients with rheumatic MS 24 patients (6 males, 18 females), aged 35.5±7.6 years, which were diagnosed as MS by echocardiogram without active rheumatism and atrial thrombus. The mitral valve area (MVA) was 1.04±0.27 cm2. The course of disease was 6.0±4.5 years with a cardiac function of NYHA Ⅱ～Ⅲ°. Among the patients 5 associated with light aortic regurgitation, 4 with light mitrl regurgitation, and 7 with atrial fibrillation. Before transeptal puncture right cardic catheterization was performed through right femoral vein to measure right ventricular and pulmanary arterial pressure, the transeptal catheterization was performed with brockenbrought needle first and then entry into the left atrium under heperinization. A guide wire was sent to left atrium, the balloon was sent along the wire to ventricle and then inflated with contrast material, expanded the valvular orifice until the waist of balloon disappeared. The times of expansion was based on the transvalvulat pressure gradient, left atrial pressure, and heart stethoscope.
, http://www.100md.com
Results: Most patients had a significant improvement of hemodynamics after the operation: the left atrial pressure (LAP) was decreased from 3.45±1.12 kPa to 1.6±0.8 kPa (P<0.01), transmitral pressure gradient (MVPG) was decreased from 2.60±0.34 kPa to 0.41±0.19 kPa (P<0.01), MVA was increased from 1.04±0.27 cm2 to 2.12±0.23 cm2 (P<0.01). One case was failed in transeptal puncture. Rapid atrial fibrillation occured in another case, but the sinus rhythm resumed after electrical conversion, and the operation was successfully accomplished. There were no severe complications, such as cardiac tamponade, severe mitral regurgitation, embolism or ventricular fibrillation.
Conclusion: MVA was increased after PBMV. The results suggest that PBMV is a safe and effective method for treatment rheumatic MS provided the operator pay great attention to every point before and during the procedure., 百拇医药
单位：：陕西省延安市，延安大学医学院附属医院(710061) 马小川 王建清；陕西省西安市，西安医科大学第一附属医院 王东琦 付 文
关键词：
目的 目的：评价经皮二尖瓣球囊成形术(PBMV)在治疗二尖瓣狭窄中的作用。
方法：采用改良Inoue单球囊技术对24例风湿性二尖瓣狭窄患者行PBMV。24例(男6例，女18例)，年龄35.5±7.6岁，病程6.0±4.5年，无风湿热活动。超声心动图明确诊断，二尖瓣口面积(MVA)1.04±0.27 cm2,无心房附壁血栓。NYHA心功能Ⅱ～Ⅲ级。其中伴轻度主动脉瓣关闭不全5例，轻度二尖瓣关闭不全4例，心房颤动7例。所有患者采用右股静脉通路。先行右心导管测定肺动脉压，右心室压力。定位卵圆窝，后前位透视下穿刺心房间隔，肝素化。送左心房导引钢丝入左心房，沿此钢丝送球囊导管进入左心室，充盈前半球囊，同时回撤球囊导管恰嵌在狭窄的二尖瓣口，迅速充盈二尖瓣球囊，扩张瓣口，至腰部凹形消失，立即抽空球囊。依据身高cm÷10+10 mm选择球囊直径。依据二尖瓣跨瓣压力阶差(MVPG)、左心房压力(LAP)、心音听诊来决定扩张的次数。统计学方法用均数±标准差，t检验。
, 百拇医药
结果：术后血液动力学显著改善。LAP从3.45±1.12 kPa降至1.60±0.80 kPa(P<0.01),MVPG从2.6±0.34 kPa降至0.41±0.19 kPa(P<0.01),MVA从1.04±0.27 cm2扩大至2.12±0.23 cm2(P<0.01)。1例心房间隔穿刺未成功。1例术中发生快速心房颤动，直流同步电复律恢复窦性心律后完成了手术。无一例发生心包填塞、严重二尖瓣关闭不全、栓塞或心室颤动等严重并发症。
结论：PBMV后MVA增加。结果亦提示，只要术前准备充分，术中仔细操作，PBMV已成为治疗风湿性二尖瓣狭窄安全有效的方法。
Clinical Analysis of the Percutaneous Balloon Mitral Valvuloplasty in 24 Cases (Abstract)
The Affiliated Hospital of Medical College of Yan′an University, Yan′an (716000), Shaanxi
, 百拇医药
Ma Xiaochuan, Wang Jianqing, Wang Dongqi, et al.
Objective: To evaluate the effect of percutaneous balloon mitral valvuloplasty (PBMV) on rheumatic mitral stenosis (MS).
Methods: The operation of PBMV was performed with improved Inoue technique in 24 patients with rheumatic MS 24 patients (6 males, 18 females), aged 35.5±7.6 years, which were diagnosed as MS by echocardiogram without active rheumatism and atrial thrombus. The mitral valve area (MVA) was 1.04±0.27 cm2. The course of disease was 6.0±4.5 years with a cardiac function of NYHA Ⅱ～Ⅲ°. Among the patients 5 associated with light aortic regurgitation, 4 with light mitrl regurgitation, and 7 with atrial fibrillation. Before transeptal puncture right cardic catheterization was performed through right femoral vein to measure right ventricular and pulmanary arterial pressure, the transeptal catheterization was performed with brockenbrought needle first and then entry into the left atrium under heperinization. A guide wire was sent to left atrium, the balloon was sent along the wire to ventricle and then inflated with contrast material, expanded the valvular orifice until the waist of balloon disappeared. The times of expansion was based on the transvalvulat pressure gradient, left atrial pressure, and heart stethoscope.
, http://www.100md.com
Results: Most patients had a significant improvement of hemodynamics after the operation: the left atrial pressure (LAP) was decreased from 3.45±1.12 kPa to 1.6±0.8 kPa (P<0.01), transmitral pressure gradient (MVPG) was decreased from 2.60±0.34 kPa to 0.41±0.19 kPa (P<0.01), MVA was increased from 1.04±0.27 cm2 to 2.12±0.23 cm2 (P<0.01). One case was failed in transeptal puncture. Rapid atrial fibrillation occured in another case, but the sinus rhythm resumed after electrical conversion, and the operation was successfully accomplished. There were no severe complications, such as cardiac tamponade, severe mitral regurgitation, embolism or ventricular fibrillation.
Conclusion: MVA was increased after PBMV. The results suggest that PBMV is a safe and effective method for treatment rheumatic MS provided the operator pay great attention to every point before and during the procedure., 百拇医药