经皮球囊二尖瓣成形术心脏穿孔与心脏压塞的处理

目的　阐明经皮球囊二尖瓣成形术 (PBMV)心脏穿孔与心脏压塞的诊断与处理方法。方法与结果　自 1992年 5月～ 2 0 0 1年 12月 ,对 772例风湿性心脏病二尖瓣狭窄患者 (年龄 14岁～ 74岁 )进行了经皮球囊二尖瓣成形术。 9例发生了心脏穿孔 ,其中 2例发生心脏压塞 ,经剑突下途径进行造影剂和X线指示下心包穿刺引流术后完全缓解 ,未行外科处理。结论　PBMV时房间隔穿刺针和Mullins鞘管导致的心脏穿孔仅少数可导致心脏压塞 ;有心脏压塞临床症状和X线透视下心影搏动消失可诊断心脏压塞 ;X线透视和造影剂指示下心包穿刺引流术是一种最快速有效的缓解症状的方法 ,多可避免开胸手术。

Management of cardiac perforation and pericardial tamponade complicating percutaneous balloon mitral valvuloplasty

Objective To determine the diagnostic and therapeutic approach of cute cardiac perforation and tamponade complicating percutaneous balloon mitral valvuloplasty. Methods and Results Percutaneous balloon mitral valvuloplasty was performed in 772 patients with rheumatic mitral stenosis from May 1992 to Dec. 2001, 9 were diagnosed cardiac perforation, 2 which developed pericardial tamponade which was successfully controlled by contrast and X ray guided pericardiocentesis using a subxiphoid approach. Conclusions Only a minority of cardiac perforation resulted from PBMV developed pericardial tamponade. The latter could be controlled safely and effectively by contrast and X ray guided pericardiocentesis using a subxiphoid approach.The diagnosis of pericardial tamponade during or after PBMV relies on a strong clinical suspicion, and contrast and X ray guided pericardiocentesis should be carried out without echocardiography for patients in unstable state.