二尖瓣球囊扩张术前后血浆一氧化氮、内皮素及血流动力学的变化

目的:研究30例风湿性心脏病二尖瓣狭窄患者经皮球囊二尖瓣扩张术(PBMV)前、后血浆一氧化氮(NO)、内皮素(ET)及血流动力学变化。方法:用化学比色法、放射免疫分析法分别测定患者 PBMV前、后的NO、ET的血浆浓度;用二维彩色多普勒超声和心导管测定二尖瓣瓣口面积(MVA)、左心房内径(LAD)、平均二尖瓣压力阶差(mMPG)、肺动脉平均压(mPAP)和左房平均压(mLAP)。结果: NO 浓度术前及术后分别为(107.350±33.614)、(74.462±23.913)μmol/L; ET 浓度术前及术后分别为(131.632±43.284)、(100.147±31.904)ng/L。NO、ET浓度术后明显低于术前( 均P<0.01)。术前MVA、LAD及mLAP、mMPG、mPAP分别为(1.026±0.201)cm2、(5.168±0.548)cm及(2.765±0.597)、(1.748±0.729)、(5.601±0.728)kPa;术后分别为(1.725±0.248)cm2、(4.895±0.585)cm及(1.738±0.418)、(0.862±0.415)、(4.155±0.436)kPa。术后血流动力学较术前有明显改善(均P<0.05),血浆NO浓度与 mLAP、mPAP呈正相关( r分别为 0.564、0.453,均 P<0.01);血浆ET浓度与mLAP、mPAP也呈正相关( r分别为0.527、0.528,均P<0.01);且 NO、ET浓度与心功能有关。结论:NO、ET可作为判断风湿性心脏病二尖瓣狭窄病情和PBMV疗效及心功能的良好指标。     

经皮二尖瓣球囊成形术治疗二尖瓣狭窄伴主动脉瓣关闭不全的疗效评价

目的　探讨风湿性心脏病 (RHD)二尖瓣狭窄 (MS)合并轻、中度主动脉瓣关闭不全 (AR)患者行经皮二尖瓣球囊成形术 (PBMV)的效果。方法　将 2 6例MS合并轻、中度AR患者 (A组 )和 34例单纯MS患者 (B组 )的PBMV术后即刻及随访结果作对比研究。结果　A组左心房平均压力(MLAP)从术前 2 3 5± 4 6mmHg降至 11 2± 2 9mmHg(P <0 0 1) ,二尖瓣跨瓣压差 (MVG)从 17 2±7 7mmHg降至 2 3± 2 6mmHg(P <0 0 1) ,二尖瓣口面积 (MVA)从 1 1± 0 2cm2 增至 2 1± 0 2cm2(P <0 0 1) ,左心房内径 (LAD)从 43 3± 5 0mm降至 36 4± 3 7mm(P <0 0 1)。二尖瓣区舒张期杂音消失率为 73%。心功能分级 (NYHA)从术前 2 7± 0 5级改善至 1 1± 0 7级 (P <0 0 1)。随访与术后比较 ,除MVA外各项指标均无显著性差异 (P >0 0 5 )。以上各项参数与B组比较 ,差异均无显著性(P >0 0 5 )。且A组随访左心室内径 (LVD)仍在正常范围 ,亦无主动脉瓣返流增加。结论　对于MS合并轻、中度AR ,PBMV是一种有效和安全的治疗措施 ,应列入PBMV的手术适应症。     

老年二尖瓣狭窄患者经皮气囊二尖瓣成形术

目的　观察老年风湿性心脏病二尖瓣狭窄患者经皮气囊二尖瓣成形术 (PBMV)的效果。方法　 34名患者 ,其中男 1 4例 ,女 2 0例 ,年龄 55～ 71 (61 5± 9 4)岁。采用Inoue管或国产导管进行PBMV并观察手术前后心功能 ,血流动力学和瓣膜超声形态变化及并发症。结果　二尖瓣面积由 (0 92± 0 2 3)cm2 增至 (1 97± 0 52 )cm2 (P <0 0 1 ) ;二尖瓣跨瓣压由 (2 54± 1 1 3)kPa下降至 (0 63± 0 52 )kPa(P <0 0 1 ) ;左心房压从 (3 0 2± 1 34)kPa降至 (1 67± 1 0 2 )kPa(P <0 0 1 ) ;术后新出现二尖瓣返流 7例 ,返流加重 6例 ,但不影响疗效。 3例术中发生脑栓塞。 1 5例在 0 5～ 3年内复诊的患者中有 3例因二尖瓣再狭窄伴心功能恶化而住院。结论　PBMV对老年二尖瓣狭窄亦能取得较好的效果 ,但病例选择、手术操作有其特殊性     

再次经皮球囊二尖瓣成形术治疗成形术后再狭窄的疗效观察

目的　评价再次经皮球囊二尖瓣成形术 (PBMV)治疗二尖瓣狭窄PBMV术后再狭窄的临床疗效。方法　采用Inoue法对 2 9例PBMV术后再狭窄患者进行再次PBMV ,并与 2 5 8例首次接受PBMV的患者进行疗效比较。结果　再次PBMV后二尖瓣口面积由 ( 0 98± 0 13)cm2 增至 ( 1 6 5±0 2 4)cm2 (P <0 0 0 1) ,二尖瓣跨瓣压差由 ( 2 6 5± 1 44 )kPa( 1kPa =7 5mmHg)降至 ( 0 79± 0 2 3)kPa(P<0 0 0 1) ,左房平均压由 ( 3 37± 0 6 2 )kPa降至 ( 1 6 6± 0 93)kPa(P <0 0 0 1) ,左房内径由 ( 4 5 2± 0 5 7)cm降至 ( 4 17± 0 5 0 )cm(P <0 0 5 )。再次PBMV组二尖瓣口面积增加值与左房平均压下降值小于首次PBMV组 [分别为 ( 0 6 7± 0 11)cm2 vs( 0 88± 0 32 )cm2 (P <0 0 5 )与 ( 1 71± 0 88)kPavs( 1 94± 0 5 6 )kPa(P <0 0 5 ) ]。再次PBMV组无心包填塞、死亡发生 ,主要并发症为重度二尖瓣反流 2例。结论只要选择合适病例 ,再次PBMV术仍可取得显著的即刻血流动力学改善 ,是PBMV术后再狭窄患者的一种安全而有效的治疗方法。     

重度二尖瓣狭窄球囊分离术42例分析

目的 探索重度二尖瓣狭窄球囊分离术治疗的新方法.方法 房间隔穿刺点定位,采用吞钡食管左心房压迹定位法,以压迹上下缘的中下1/4水平线为房间隔穿刺高度,与脊柱中右1/4垂线的交点为房间隔穿刺点,穿刺成功率100%.穿刺成功后于右前斜位25°下行直接左心房造影,根据二尖瓣口位置调整二尖瓣探条(stylet),引导Inoue球囊过二尖瓣口,必要时在超声心动图指导下进左心室,选用直径23～28mm球囊扩张.结果 全部患者均成功,跨二尖瓣压差自18～51(34±11)mmHg降至4～9(7±3)mmHg(t=2.623,P<0.01).左心房平均压自20～60(38±13)mmHg,降至6～13(8±3)mmHg,二尖瓣听诊区雷鸣样舒张期杂音明显减轻或消失,效果显著(t=2.714,P<0.01).结论 对于风湿性心脏病重度二尖瓣狭窄,食管左心房压迹定房间隔穿刺点,安全而方便.右前斜位25°下,直接左心房造影显示二尖瓣口,指导Inoue球囊导管进左心室成功率高.     

二尖瓣球囊扩张术对患者血浆B型利钠肽水平的影响

目的:观察二尖瓣球囊扩张术(PBMV)对二尖瓣狭窄患者血浆B型利钠肽(BNP)水平的影响。方法:检测30例成功施行PBMV的二尖瓣狭窄患者(窦性心律21例,心房颤动9例)术前、术后20 min及术后24 h的血浆BNP浓度,与8例对照者比较,并将BNP浓度与血流动力学参数作相关分析。结果:术前30例二尖瓣狭窄患者血浆BNP水平显著高于对照者(P<0．01);且与平均左心房压(r=0．441,P< 0．05)和肺动脉压(r=0．488,P<0．01)呈正相关。心房颤动患者与窦性心律患者BNP浓度无明显差异。术后20 mim及术后24 h窦性心律患者BNP浓度较术前显著下降(P均<0．05),术后24 h左心室舒张末容量(P<0．01)和每搏输出量(P<0．05)较术前相应增加,左心室舒张末压不变;术后20 min的BNP浓度变化与平均左心房压变化(r=0．696,P <0．01)及肺动脉压变化(r=0．456,P<0．05)呈正相关。术后心房颤动患者BNP浓度较术前无明显改变,左心室舒张末容量和每搏输出量相应不变,左心室舒张末压术后20 min较术前增加(P<0．01)。结论:二尖瓣狭窄患者血浆BNP浓度升高和左心房压及肺动脉压升高相关。心脏节律对球囊扩张术后血浆BNP的变化起重要作用,BNP是反映窦性心律患者球囊扩张术后左心房压及肺动脉压变化的敏感指标,但这一指标不适用于心房颤动患者。     

彩色多普勒超声评估经皮球囊二尖瓣成形术前、后左心室舒张功能

目的　探讨多普勒超声评估经皮球囊二尖瓣成形术 (PBMV)前、后左心室舒张功能的可行性。方法　利用彩色多普勒超声测量 11例窦性心律的风湿性二尖瓣狭窄患者行 PBMV术前、后的肺静脉血流 (PVF) ,使用猪尾导管测量 PBMV术前后左心房压力。结果　 PBMV术后 ,肺静脉收缩期血流峰值 (PVs)从 4 9± 0 .0 6 cm/ S增至 6 3±0 .0 7,P<0 .0 1。肺静脉舒张期正向血流峰值 (PVd)从 4 4 .32± 8.2 6增至 5 1.2 3± 7.98,P<0 .0 5 ,肺静脉舒张期逆向血流峰值 (PVa)从 36 .5 7± 3.89降至 2 3.4 5± 3.35 ,P<0 .0 1,PVa与 L AP呈正相关 ,r=0 .76 ,P<0 .0 5。结论　彩色多普勒超声测定肺静脉血流能有效的估测左心房压力和左心室舒张功能。     

影响经皮二尖瓣球囊成形术术后肺动脉压力正常化的相关因素研究

目的　探讨继发性肺小动脉病变对经皮二尖瓣球囊成形术 (PBMV)术后肺动脉高压正常化的影响。方法　对 5 2 3例二尖瓣狭窄合并肺动脉高压的患者 ,PBMV术前、后测定其肺动脉收缩压 (PASP)、左房收缩压 (LASP)等血流动力学指标 ,运用多因素logistic回归分析影响术后肺动脉压正常化的因素 ,并将患者分为重度肺动脉高压组 (A组 )和非重度肺动脉高压组 (B组 )进行比较分析。结果　A组患者的PASP由术前的 (89 6 9± 16 2 7)mmHg(1mmHg =0 133kPa)下降为术后的 (5 3 0 4±16 5 2 )mmHg ,B组患者的PASP值由术前的 (48 2 3± 11 4 7)mmHg降至术后的 (33 6 4± 9 0 1)mmHg。logistic回归表明 ,术前PASP水平高是影响术后肺动脉压正常化的显著因素。A组中术后肺动脉压力下降至正常的患者比例 (4 5 % )明显低于B组 (42 5 % ) ;与B组比较 ,A组患者无论在术前、术后LASP与PASP均缺乏良好的线性关系。结论　由于继发性肺小血管改变引起的“二级狭窄”是造成PBMV术后肺动脉压力不能恢复至正常的主要原因。     

经皮球囊二尖瓣成形术治疗伴巨大左心房的重度二尖瓣狭窄的临床研究

目的:评价经皮球囊二尖瓣成形术(PBMV)治疗风湿性心脏病(风心病)重度二尖瓣狭窄(MS)合并巨大左心房的可行性、安全性和有效性。方法:风心病重度MS合并巨大左心房患者共28例,其中男9例,女19例,年龄20～51(34.9±7.5)岁。采用常规及改良的非常规方法进行PBMV。以手术前后肺动脉平均压、左房平均压、二尖瓣跨瓣压差及左心房直径、二尖瓣口面积等血流动力学指标评估PBMV效果,并观察有无体循环血栓栓塞等并发症。结果:PBMV成功率为100%。与术前相比较,术后肺动脉平均压下降[(42.28±7.58)mmHg(1mmHg=0.133kPa)∶(23.17±5.99)mmHg]、左心房平均压下降[(28.11±6.18)mmHg∶(13.11±4.43)mmHg]、二尖瓣跨瓣压差显著下降[(19.55±6.14)mmHg∶(7.87±3.01)mmHg)],差异均具有统计学意义(P<0.001);同时左心房直径明显减小[(68.61±8.92)cm∶(51.39±7.88)cm]、二尖瓣口面积增大[(0.75±0.17)cm2∶(1.87±0.33)cm2],差异亦均具有统计学意义(P<0.01),心功...     

经皮球囊导管二尖瓣成形术100例与53例随访

本文报道经皮球囊导管二尖瓣成形术(PBMV)治疗风湿性心脏病二尖瓣狭窄100例.94例平均左房压从22.77±0.84mmHg降至12.40±0.57mmHg,二尖瓣跨瓣压差从13.06±1.03mmHg减为3.99±0.77mmHg,二尖瓣面积从1.04±0.03cm~2增加为1.93±0.08cm~2(P值均<0.01).主要并发症包括术后48小时死于低心排1例(1%)、心脏穿孔3例(3%)、脑栓塞2例(2%).53例随访1～3年症状明显改善.无1例发生再狭窄.初步和较长期随访结果证实PMV是治疗风心二尖瓣狭窄的、较开胸手术安全、有效的方法.     

Increased circulating endothelin-1 in rheumatic mitral stenosis: irrelevance to left atrial and pulmonary artery pressures

BACKGROUND: Increased plasma endothelin (ET)-1 concentrations have been observed in patients with rheumatic mitral stenosis (MS). However, the mechanisms of increased circulating ET-1 in patients with MS remain unclear. METHODS: We measured plasma concentrations of ET-1 in blood samples from the femoral vein and artery, and right and left atria obtained from 20 patients with moderate-to-severe rheumatic MS before and after percutaneous transluminal mitral valvuloplasty (PTMV) [group 1; 16 patients in chronic atrial fibrillation and 4 patients in sinus rhythm]. In addition, we measured plasma concentrations of ET-1 in the peripheral venous blood samples obtained from 22 control patients (including 14 healthy volunteers in sinus rhythm [group 2] and 8 patients in chronic lone atrial fibrillation [group 3]). Plasma ET-1 concentrations were measured by solid-phase, sandwich enzyme-linked immunosorbent assay. RESULTS: The peripheral venous plasma concentrations of ET-1 were significantly higher in group 1 patients (2.46 +/- 0.90 pg/mL) than in group 2 and group 3 patients (0.74 +/- 0.42 pg/mL and 0.99 +/- 0.41 pg/mL, respectively [mean +/- SD]; p < 0.0001). However, there was no significant difference in the peripheral venous concentrations of ET-1 between group 2 and group 3 patients. In group 1 patients, the plasma ET-1 concentration in the femoral vein (2.46 +/- 0.90 pg/mL) was significantly higher than that in the right atrium (2.02 +/- 0.69 pg/mL), left atrium (2.11 +/- 0.99 pg/mL), and femoral artery (2.05 +/- 0.75 pg/mL) [p = 0.0001]. The plasma ET-1 concentration in the femoral vein was not correlated with the mean left atrial pressure (r = 0.05; p = 0.838) and mean pulmonary artery pressure (r = 0.07; p = 0.757). The plasma ET-1 concentration in the left atrium was also not correlated with the mean left atrial pressure (r = 0.11; p = 0.656), mean pulmonary artery pressure (r = 0.06; p = 0.788), or mitral valve area (r = 0.02; p = 0.936). Although the area of mitral valve increased significantly (1.06 +/- 0.17 cm(2) vs 1.48 +/- 0.32 cm(2); p < 0.0001), and the mean left atrial pressure (23.0 +/- 5.1 mm Hg vs 17.6 +/- 5.9 mm Hg; p < 0.0001) and mean pulmonary arterial pressure (31.0 +/- 7.9 mm Hg vs 25.5 +/- 7.0 mm Hg; p < 0.001) fell significantly and immediately after PTMV, there were no significant changes in the plasma ET-1 concentrations in the femoral vein, right atrium, left atrium, and femoral artery immediately after PTMV. CONCLUSION: Increased production of ET-1 in the pulmonary circulation in response to increased pulmonary artery pressure was not the mechanism of increased circulating ET-1 concentration in patients with MS. We proposed that one of the mechanisms of increased ET-1 concentration in the femoral vein was increased peripheral ET-1 release due to increased systemic venous pressure and mechanical damage of the endothelium.     

二尖瓣形态对经皮球囊二尖瓣成形术近远期疗效的影响

目的 观察不同瓣膜形态的二尖瓣狭窄患者行经皮球囊二尖瓣成形术的近远期疗效.方法 根据Wilkins超声二尖瓣形态学积分,将385例二尖瓣狭窄患者分为＞8分组(125例)和≤8分组(260例).均采用改良Inoue法对患者行经皮球囊二尖瓣成形术.术后进行随访,并比较两组患者的临床疗效.结果 经皮球囊二尖瓣成形术成功370例,＞8分组经皮球囊二尖瓣成形术的成功率低于≤8分组(92.8％比97.7％,P＜0.05).术后6个月,两组患者各项超声心动图检查指标均较术前显著改善(均P＜0.05);与≤8分组(254例)比较,＞8分组(116例)经皮球囊二尖瓣成形术后左心房平均压、肺动脉收缩压、跨瓣压差及二尖瓣瓣口面积的改变值均较小[分别为(14.22±5.02)mm Hg(1 mm Hg=0.133 kPa)比(15.44±5.19) mm Hg、(26.13±9.27) mm Hg比(31.93±9.98)mm Hg、(9.21±4.11)mm Hg比(10.16 ±4.21)mm Hg和(1.02±0.15)cm2比(1.20±0.22)cm2,均P＜0.05].经皮球囊二尖瓣成形术成功且完成远期随访[(78±20)个月]的患者共353例,两组患者各项超声心动图检查指标均较术前显著改善(均P＜0.05);与≤8分组(245例)比较,＞8分组(108例)左心房平均压、肺动脉收缩压、跨瓣压差及二尖瓣瓣口面积的改变值均较小[分别为(13.28±5.06) mm Hg比(14.77±5.17)mm Hg、(21.19±9.17) mm Hg比(28.92±9.91) mm Hg、(7.30±4.40)mm Hg比(9.16±4.28)mm Hg和(0.92±0.17)cm2比(1.07±0.20)cm2,均P＜0.05],且再狭窄发生率较高(20.4％比8.2％,P＜0.05).结论 二尖瓣瓣膜形态是决定经皮球囊二尖瓣成形术疗效的关键因素之一.对于超声二尖瓣形态学积分低的患者,经皮球囊二尖瓣成形术成功率较高,术后近期及远期随访疗效较好,再狭窄发生率较低,治疗方案可优先选择经皮球囊二尖瓣成形术.     

经皮二尖瓣球囊扩张术治疗老年人二尖瓣狭窄的临床观察

目的 探讨经皮二尖瓣球囊扩张术(PBMV)治疗老年人二尖瓣狭窄的疗效、安全性及并发症的预防.方法 采用改良的房间隔定位法及运用跨二尖瓣技术对老年二尖瓣狭窄患者行逐步球囊扩张.手术前后分别记录即刻左心房压、肺动脉平均压、二尖瓣跨瓣压差及二尖瓣口面积,并进行手术后随访.结果 PBMV有效扩大了二尖瓣口面积,与术前比较,术后左心房压下降[分别为(25.3±6.7)mm Hg(1 mm Hg=0.133 kPa)与(16.4±5.8)mm Hg]、二尖瓣跨瓣压下降[分别为(17.6±6.7)mm Hg与(6.8±2.9)mm Hg]、肺动脉压下降[分别为(38.6±12.1)mm Hg与(29.2±9.8)mm Hg],二尖瓣口面积增加[分别为(1.05±0.22)cm2与(1.61±0.38)cm2],心功能明显改善,差异均有统计学意义(P＜0.05或P＜0.01).随访结果表明,PBMV疗效稳定.结论 PBMV操作技术的改进能明显改善老年患者二尖瓣狭窄症状,显著降低手术的并发症.

Abstract：

Objective To evaluate the efficacy and safety of the improved percutaneous balloon mitral valvuloplasty (PBMV) in elderly patients with mitral stenosis. Methods Elderly patients with severe mitral stenosis received an improved PBMV which included a modified way of atrial septal puncture and technique across the mitral valve. The left atrial pressrue (LAP), mean pulmonary pressure (MPA), mean gradient across the mitral value (MPG) and mitral valve area (MVA) were recorded and compared before and after the operation. Long term follow up were made. Results After operation, the LAP decreased [(25.3±6.7) mm Hg vs.(16.4±5.8) mm Hg,1 mm Hg=0.133 Kpa], MPG decreased [(17.6±6.7) mm Hg vs.(6.8±2.9) mm Hg], MPA decreased [(38.6±12.1) mm Hg vs. (29.2±9.8) mm Hg], MVA increased [(1.05±0.22)cm2 vs.(1.61±0.38)cm2] and the New York heart association heart function classification improved. The follow-up result showed that the effect of PBMV was constant. Conclusions Improved PBMV may be an effective and safe measure for patients with mitral stenosis.     

再次经皮球囊二尖瓣成形术39例远期疗效观察

目的 观察经皮球囊二尖瓣成形术后再狭窄的患者,行再次经皮球囊二尖瓣成形术的远期疗效.方法 39例经皮球囊二尖瓣成形术后再狭窄的患者,全部采用改良Inoue法,再次行经皮球囊二尖瓣成形术,并进行远期疗效随访.结果 39例患者再次行经皮球囊二尖瓣成形术,成功36例(成功率为92.3%).再次经皮球囊二尖瓣成形术成功后,患者临床症状及部分血流动力学指标(左心房平均压、二尖瓣瓣口面积、跨瓣压差及肺动脉收缩压)明显改善[分别为(24.50±6.54)mm Hg比(9.66±4.21)mill Hg(1 mm Hg=0.133 kPa),(1.05±0.19)cm2比(2.23±0.22)cm2,(17.03±4.52)mm Hg比(7.79±4.07)mm Hg,(58.12±12.68)mm Hg比(31.45±10.02)mm Hg,P均＜0.05];而左心房内径无明显改变[(4.71±0.75)cm比(4.07±0.69)cm,P＞0.05]. 36例患者再次经皮球囊二尖瓣成形术后随访12～146(69±23)个月,远期随访可见二尖瓣瓣121面积仍明显大于术前[(2.02±0.21)cm2比(1.05±0.19)cm2,P＜0.05],跨瓣压差明显小于术前[(9.15±4.11)mm Hg比(17.03±4.52)mm Hg,P＜0.05],且均与近期随访结果相近似[分别为(2.02±0.21)cm2比(2.23±0.22)cm2,(9.15±4.11)mm Hg比(7.79±4.07)mm Hg,P均＞0.05];而左心房内径仍无明显改变[(4.13±0.71)cm比(4.07±0.69)cm,P＞0.05].远期随访期间,大多数患者心功能及生活质量均明显改善.结论 对于经皮球囊二尖瓣成形术后再狭窄的患者,只要病例选择恰当,手术操作正确,再次行经皮球囊二尖瓣成形术的近期及远期疗效均佳.     

The effect of percutaneous balloon mitral valvuloplasty on N-terminal- pro B- type natriuretic peptide plasma levels in mitral stenosis

The objectives of this study were to assess the effect of percutaneous mitral balloon valvuloplasty (PBMV) on the plasma levels of N-terminal-pro B-type natriuretic peptide (NT-proBNP) in patients with mitral stenosis (MS) and to investigate the relationship between the changes in hemodynamic variables and NT-proBNP levels after PBMV. Plasma NT-proBNP concentrations were obtained from 60 symptomatic patients with rheumatic MS who underwent PBMV, and in 35 age- and gender-matched healthy volunteers. Patients with MS were found to have significantly higher levels of plasma NT-proBNP compared to the control group (293 [77-1093] pg/mL versus 24 [12-67] pg/mL, respectively; [P < 0.001]). The mean preprocedural NT-proBNP level fell significantly from 293 (77-1093) pg/mL to 214 (69-1028) pg/mL (P < 0.001) following PBMV. The percentage decrease in plasma NT- proBNP levels was correlated only with the percentage decrease in systolic pulmonary artery pressure (r = 0.687, P < 0.001) and this correlation persisted in linear regression analysis (beta = -0.013; 95% CI [-0.018- -0.008] and P < 0.001). However, NT-proBNP levels did not correlate with the percentage of improvement in NYHA functional class, mitral valve gradients, or left atrial pressure (all P > 0.05). These findings indicate that NT-proBNP measurement following PBMV may be valuable for evaluating changes in pulmonary artery pressure and that elevated NT- proBNP levels in patients with MS may reflect the increased wall stress in the left atrium and right side of the heart.     

Atrial natriuretic peptide and vasopressin during percutaneous transvenous mitral valvuloplasty and relation to renin-angiotensin-aldosterone system and renal function

To study the relation between plasma atrial natriuretic peptide (ANP) and cardiac pressure, and to assess the pathophysiologic significance of ANP in water and electrolyte metabolism, the changes in plasma levels of ANP and arginine vasopressin (AVP) were examined in 11 patients with mitral stenosis who underwent percutaneous transvenous mitral valvuloplasty, and compared with the changes in the renin-angiotensin-aldosterone system and renal function. Immediately after valvuloplasty, plasma ANP levels decreased significantly with a concomitant decrease in mean pressures in the left atrium, the pulmonary artery and the right atrium. Plasma ANP levels decreased to the normal range in 4 of the 6 patients with normal sinus rhythm, while all 5 patients with atrial fibrillation had higher levels despite a similar degree of decrease in atrial pressure. There were significant positive correlations between plasma ANP levels and the mean left atrial pressure (r = 0.61, p less than 0.01), the mean pulmonary arterial pressure (r = 0.49, p less than 0.01) and the mean right atrial pressure (r = 0.54, p less than 0.01). The mean plasma AVP levels, on the other hand, showed a transient increase after valvuloplasty from 0.5 +/- 0.1 to 1.2 +/- 0.4 pg/ml (p less than 0.05). The mean plasma renin activity (1.3 +/- 0.3 vs 2.7 +/- 0.8 ng/ml/hr, p less than 0.05) and plasma aldosterone concentration (8.6 +/- 2.3 vs 17.2 +/- 5.2 ng/dl, p less than 0.05) also increased significantly 30 minutes after valvuloplasty.(ABSTRACT TRUNCATED AT 250 WORDS)     

缬沙坦联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性的影响

目的 比较缬沙坦联合氨氯地平或氢氯噻嗪对老年高血压患者血压变异性及一氧化氮、内皮素的影响.方法选取61例2、3级老年高血压患者,随机分为两组,分别给予缬沙坦+氨氯地平或缬沙坦+氢氯噻嗪行降压治疗,观察入选时、治疗第8周和第16周各种相关指示的变化.人选时检测血脂、空腹血糖、血尿酸,试验各个阶段监测24 h动态血压,检测血浆一氧化氮、内皮素水平.结果在患者入选时、治疗第8周和第16周三个时间点,缬沙坦+氨氯地平组和缬沙坦+氢氯噻嗪组24 h血压及白昼血压比较差异无统计学意义.治疗第16周,缬沙坦+氨氯地平组晨峰收缩压较缬沙坦+氢氯嚷嗪组明显降低[(22.6±8.8)mm Hg(1 mm Hg=0.133 kPa)比(26.3±13.7)mm Hg,P＜0.05];缬沙坦+氨氯地平组及缬沙坦+氢氯噻嗪组24 h收缩压变异性(SBPV)进行性降低[缬沙坦+氨氯地平组:(12.5±2.8)mm Hg比(10.2 ±2.2)mm Hg比(8.8±1.6)mm Hg,P＜0.01;缬沙坦±氢氯噻嗪组:(12.5±2.5)mmHg比(10.7±2.2)mm Hg比(9.6±2.0)mmHg,P＜0.01],缬沙坦+氨氯地平组及缬沙坦+氢氯噻嗪组白昼SBPV明显降低[缬沙坦+氨氯地平组:(12.2±3.0)mm Hg比(10.1±2.3)mm Hg比(8.4±1.9)mm Hg,P＜0.01;缬沙坦+氢氯噻嗪组:(11.8±2.7)mm Hg比(10.4±1.9)mm Hg比(9.6±2.2)mm Hg,P＜0.01],缬沙坦+氨氯地平组24 h舒张压变异性(DBPV)显著降低[(15.5±3.4)mm Hg比(13.0±3.5)mm Hg比(12.3±2.5)mm Hg,P＜0.01],缬沙坦+氢氯噻嗪组24 h DBPV无显著性变化;缬沙坦+氨氯地平组第16周白昼SBPV低于缬沙坦+氢氯噻嗪组[(8.4±1.9)mm Hg比(9.6 ±2.2)mm Hg,p＜0.05],缬沙坦+氨氯地平第8周、第16周的24 h DBPV、白昼DBPV低于缬沙坦+氢氯噻嗪组(P ＜0.01～0.05);缬沙坦+氨氯地平组一氧化氮进行性升高[(27.3±13.6)μmol/L比(47.2±16.3)μmol/L比(69.5±18.9)μmol/L,P＜0.01]、内皮素进行性降低[(45.3±8.0)ng/L比(37.4±3.9)ng/L比(34.2±4.4)ng/L,P＜0.01];缬沙坦+氢氯噻嗪组一氧化氮进行性升高[(33.5±13.9)μmol/L 比(49.7±21.9)μmol/L比(66.7 ±24.7)μmol/L,P＜0.01]、内皮素显著降低[(46.6±10.4)ng/L比(37.0±5.4)ng/L比(36.1±8.2)ng/L,P＜0.01].治疗第8周,缬沙坦+氨氯地平组收缩压变异性的降幅与一氧化氮的升幅有相关性(r =0.401,P=0.025).结论缬沙坦联合氨氯地平或氢氯噻嗪均能降低老年高血压患者血压变异性、改善血管内皮功能,缬沙坦联合氨氯地平可能更适合于老年高血压患者.     

Rapid increase in plasma endothelin concentrations during percutaneous balloon dilatation of the mitral valve in patients with mitral stenosis.

OBJECTIVE--To investigate the relation between plasma concentrations of immunoreactive endothelin and haemodynamic variables before and after percutaneous transvenous balloon dilatation of the mitral valve. DESIGN--Prospective study. SETTING--National cardiovascular centre. PATIENTS--25 patients with mitral stenosis and 26 healthy volunteers. MAIN OUTCOME MEASURES--Plasma concentrations of immunoreactive endothelin were measured in the pulmonary artery, left atrium, ascending aorta, and femoral vein before and after balloon dilatation of the mitral valve. RESULTS--Peripheral venous concentrations (mean (SD)) of endothelin were higher in the patients with mitral stenosis than in the healthy volunteers (1.76 (0.51) v 1.37 (0.45) pg/ml, p < 0.05) and they correlated with the mean left atrial pressure (r = 0.74, p < 0.01). Balloon dilatation of the mitral valve reduced the mean left atrial pressure without changing the mean right atrial pressure, systemic arterial pressure, heart rate, or cardiac index. Concentrations of plasma endothelin in the femoral vein increased from 1.76 (0.51) to 3.39 (2.46) (p < 0.01), 4.82 (2.34) (p < 0.001), and 2.43 (0.52) pg/ml (p < 0.05) at 15 and 30 minutes and 24 hours after the procedure. The concentration of endothelin in the pulmonary artery also increased from 1.85 (0.85) to 4.32 (1.58) pg/ml (p < 0.01) 30 minutes after the dilatation, whereas there were no appreciable changes in endothelin concentration in the left atrium or ascending aorta. CONCLUSIONS--Plasma endothelin concentrations were higher in patients with mitral stenosis than in healthy volunteers and the increase was proportional to left atrial pressure. After balloon dilatation of the mitral valve there was an abrupt rise in endothelin in the femoral vein and pulmonary artery but no change in left atrial or aortic blood samples. These findings suggest that endothelin may be another vasoactive substance involved in congestive heart failure.     

Atrial natriuretic polypeptide is removed by the lungs and released into the left atrium as well as the right atrium in humans

To examine the sites of release and removal of plasma atrial natriuretic polypeptide plasma levels in the femoral vein, right atrium, pulmonary artery, pulmonary capillary bed, left atrium and aortic root were measured in 11 control subjects and 22 patients with mitral stenosis. Mean plasma natriuretic polypeptide levels in the femoral vein, right atrium, pulmonary artery, pulmonary capillary bed, left atrium and aortic root were, respectively, 64 +/- 29, 124 +/- 72, 103 +/- 44, 83 +/- 30, 106 +/- 46 and 101 +/- 35 pg/ml in the control subjects and 321 +/- 170, 500 +/- 234, 458 +/- 266, 356 +/- 209, 434 +/- 222 and 432 +/- 217 pg/ml in the patients with mitral stenosis. In both the control subjects and the patients with mitral stenosis, there was a significant increase between the femoral vein and the right atrium and between the pulmonary capillary bed and the left atrium and a significant decrease between the pulmonary artery and the pulmonary capillary bed. Blood samples were also taken simultaneously from the pulmonary vein and the pulmonary capillary bed, as well as from the pulmonary artery and the left atrium, in 25 patients (11 control subjects, 5 patients with mitral stenosis and 9 patients with atrial septal defect). There was no difference in plasma atrial natriuretic polypeptide levels between the pulmonary capillary bed and the pulmonary vein in these 25 patients. It is concluded that atrial natriuretic polypeptide 1) is released into the left as well as the right atrium, and 2) is removed by the lungs.     

风湿性二尖瓣狭窄伴左室偏小患者球囊扩张术后的近期临床观察

目的　观察风湿性二尖瓣狭窄伴左室偏小患者经皮二尖瓣球囊扩张术 (PBMV)的球囊直径及扩张后心功能 ,血流动力学及心腔大小的变化。方法　选择风湿性二尖瓣狭窄伴左室偏小患者共 2 7例 ,采用Inoue法行PBMV ,球囊扩张直径为身高 / 10 +10mm ,分别测定其扩张前后左房及左室压力 ;随访其术前及术后近期心功能 ;超声评价术前 1周、术后 1周、1、3、6月二尖瓣瓣口面积、二尖瓣跨瓣压差、最大肺动脉收缩压及心腔大小的变化。结果　扩张即刻左房压力及二尖瓣跨瓣压差明显下降 ,舒张期杂音减轻 ,左室舒张末期压力增加 ;术后一周左房内径变小 ,左室内径增大 ,心功能改善不明显 ;术后一月左房内径变小 ,左室内径增大及心功能改善均达最佳效果 ,并维持至观察结束时。结论　风湿性二尖瓣狭窄伴左室偏小患者仍可以球囊直径 =身高 / 10 +10mm进行扩张 ;术后 1周心腔大小明显变化 ,1月达最佳效果 ;心功能的改善 1月才达最佳效果。