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。

Evaluation of the short-term clinical outcomes (the changes of cardiac function, cardiac cavity size and hemodynamic) after percutaneous balloon mitral valvuloplasty in patients with rheumatic mitral stenosis and small left ventricle

Objective To evaluate the changes of cardiac function, cardiac cavity size and hemodynamic after percutaneous balloon mitral valvuloplasty (PBMV) in patients with rheumatic mitral stenosis and small left ventricle Methods PBMV was performed with Inoue technique in 27 patients with rheumatic mitral stenosis and small left ventricle The diameter of balloon was the height (cm) of patient/10+10 mm To measure the changes of hemodynamic during PBMV; to evaluate the cardiac function, size of the left atrium and ventricle, mitral valve area and its mean gradient, maximal pulmonary systolic pressure by echocardiogram 1 week before PBMV and 1 week, 1, 3, 6 month after PBMV Results The left atrial pressure, mean gradient and diastolic murmur decreased; and diastolic pressure of left ventricle increased immediately after PBMV; the cardiac function improved at 1 month after PBMV Conclusion The diameter of balloon can be height (cm) of patient/10+10 mm in the patients with rheumatic mitral stenosis and small left ventricle The cardiac cavity size has significant changes at 1 week and the largest effect was seen at 1 month At 1 month the cardiac function has been improved apparently