经皮球囊二尖瓣成形术治疗风湿性二尖瓣狭窄疗效的初步探讨

【】目的 探讨经皮球囊二尖瓣成形术( PBMV) 治疗风湿性二尖瓣狭窄患者的近期疗效。方法 将我院2013 年9 月-2016 年01月14 例应用PBMV治疗的风湿性二尖瓣狭窄患者按照年龄分为A组(年龄＜60岁)、B组(年龄≥60岁),两组分别用心导管测定患者PBMV 前后的左心房压力、肺动脉压力,心脏超声评价PBMV 前后二尖瓣口面积、二尖瓣口血流速度、二尖瓣反流面积及左房内径、左室舒张末径、右房内径、右室舒张末径、左室每搏输出量、左室射血分数等指标。将两组数据进行统计分析。结果 PBMV成功率100%,无围手术期并发症及死亡病例。A组、B组在PBMV 前、后所有参数比较均无统计学意义(P＜0.05)。结论PBMV 治疗风湿性二尖瓣狭窄有效,高龄患者(≥60岁)亦可以从该术式获益。     

二尖瓣狭窄并中度反流的经皮二尖瓣球囊扩张术42例及随访观察

目的　探讨二尖瓣狭窄 (MS)并中度反流 (MR)患者经皮二尖瓣球囊扩张术 (PBMV)近远期疗效。方法　采用Inoue单球囊对 42例风心病二尖瓣狭窄并中度反流患者行PAMV治疗。结果　二尖瓣口面积由 (0 92± 0 2 2 )cm2 增至 (1 94± 0 2 5 )cm2 (P <0 0 1) ;二尖瓣跨瓣压差由 (2 7± 1 0 1)kPa降至 (1 0 2± 0 5 6 )kPa(P <0 0 1) ;心功能由 (2 6 1± 0 2 2 )级改善至 (1 42± 0 46 )级 (P <0 0 1) ;左室最大前后径无明显变化 (P >0 0 5 )。 2例患者二尖瓣反流较术前加重。随访 37例患者 (18± 4)个月 ,二尖瓣口面积、左室最大前后径及心功能与术后比较 ,均无明显变化 (P >0 0 5 )。结论　掌握好病例选择 ,严格把握球囊扩张尺度 ,风心病二尖瓣狭窄并中度反流患者PBMV近、远期疗效满意     

风湿性二尖瓣狭窄伴心房颤动二尖瓣球囊扩张术疗效评价

对26例风湿性二尖瓣狭窄伴心房纤额（房颤二狭）与同期31例风湿性二尖瓣狭窄无房颤（窦律二狭）患者PBMV术后及随访结果进行比较，结果显示：虽然房颤二狭具有血栓发生率高、左房前后径大、瓣膜超声评分高等特殊性，但只要术前抗凝准备充分，操作仔细，房颤二狭接受PBMV治疗与窦律二狭一样具有良好的安全性和临床效果。     

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...     

Percutaneous balloon mitral valvuloplasty in rheumatic mitral stenosis: an experience of 50 patients in India

We attempted percutaneous balloon mitral valvuloplasty in 50 patients (27 female and 23 male, age 10-38 years) with rheumatic mitral stenosis. The procedure could be completed in 40 patients. The failures were caused by problems related to transseptal puncture in eight cases and inability to cross the mitral valve in two cases. Immediately after valvuloplasty there was a remarkable reduction in the mean pulmonary artery pressure, left atrial mean pressure, mean diastolic gradient across the mitral valve, and the calculated pulmonary vascular resistance. The calculated mitral valve area increased and the cardiac index increased marginally. Inadequate results with a post valvuloplasty mitral valve area of 0.9 cm2 were seen in only one patient. Repeat hemodynamic evaluation in 25 patients within two weeks of valvuloplasty showed persistent benefit in all except one patient, who showed partial restenosis. Follow-up cardiac catheterization at 3-6 months in 13 patients showed evidence of restenosis (mitral valve area less than 1.0 cm2 and mean diastolic gradient of greater than 10 mmHg) in one patient, while all others maintained hemodynamic benefit. Repeat hemodynamic evaluation at 9-18 months after valvuloplasty in eight patients showed evidence of restenosis in an additional two cases. The patients in our series are young (28 patients less than 20 years), small body surface area (1.35-0.2 m2), and have high left atrial and pulmonary arterial pressures.     

Percutaneous balloon valvuloplasty in mirror-image dextrocardia and rheumatic mitral stenosis

A 28-year-old woman with mirror-image dextrocardia and severe rheumatic mitral stenosis underwent successful percutaneous balloon mitral valvuloplasty (PBMV). Standard technique was altered to include transseptal catheterization via the left femoral vein and inter-atrial septal puncture with the transseptal needle rotated to a 7 o'clock position. The predilatation transmitral gradient (mean) of 16 mmHg decreased to 5 mmHg following PBMV. The valve area improved from 1.0 cm² to 2.6 cm². There were no complications. This case illustrates that transseptal catheterization can be accomplished safely in patients with unusual cardiac anatomy and mitral valvuloplasty can be performed in patients with mirror-image dextrocardia and rheumatic mitral stenosis. © 1993 Wiiey-Liss, Inc.     

风湿性二尖瓣狭窄伴心房纤颤球囊二尖瓣成形术后心房纤颤的复律治疗

报道９０例风湿性二尖瓣狭窄伴心房纤颤（简称二狭房颤）球囊二尖瓣成形术（ＰＢＭＶ）后复律治疗的结果。８９例患者在ＰＢＭＶ后２周内接受复律治疗，１５例服用奎尼丁后恢复窦性心律，７４例经体表电复律转为窦性心律。随访２３．５±１１．７个月，２４例（２７％）患者心房纤颤复发。我们认为心房纤颤病程长，ＰＢＭＶ后瓣口面积小和左房回缩差是心房纤颤复发的可能原因。     

老年患者二尖瓣狭窄球囊成形术并发症的防治

目的 降低老年患者二尖瓣球囊成形术的并发症.方法 对57例老年二尖瓣狭窄患者进行经皮二尖瓣球囊成形术(PBMV).将患者分为A组27例,男性11例,女性16例,年龄60～72(66±5)岁,采用传统的PBMV技术;B组30例,男性10例,女性20例,年龄60～70(64±5)岁,采用改进的PBMV技术,主要包括4种方法监控定位行房间隔穿刺;根据左心房大小调整二尖瓣导向探条前段的J形弧度;3种方法监控球囊导管是否已进入左心室并判断其未卡在腱索内;微级递增球囊直径扩张二尖瓣口等.结果 A组并发症为26%(7/27),其中中～重度二尖瓣关闭不全4例,缓慢性心律失常及低血压2例,心包填塞1例;B组仅3%(1/30)发生中度二尖瓣关闭不全,两组比较,差异有显著性意义(P＜0.05).超声心动图显示左心房内云雾状改变不是PBMV的禁忌证.结论 PBMV操作技术的改进可显著降低老年患者PBMV手术的并发症.     

经皮二尖瓣球囊成形术治疗伴重度钙化的二尖瓣狭窄

目的 :探讨风湿性心脏病 (RHD)伴重度钙化的二尖瓣狭窄 (MS)患者行经皮二尖瓣球囊成形术 (PB MV)的近期疗效及安全性。方法 :对 33例伴重度钙化的MS患者行逐步球囊扩张法PBMV治疗 ,术中监测左房平均压等 ,术前、术后 3个月进行心脏超声心动图检查 ,并对结果进行统计分析。结果 :术后左房压、二尖瓣跨瓣压差显著下降 ;超声心动图示二尖瓣口面积显著扩大 ,心功能显著改善 ,左房内径、二尖瓣跨瓣压差、肺动脉收缩压显著减小 ,左室内径无显著变化。结论 :逐步扩张法PBMV治疗伴重度钙化的MS是一种安全、有效的方法。     

提高经皮二尖瓣球囊成形术疗效及防止并发症的经验和体会

目的通过１５２例经皮二尖瓣球囊成形术（ＰＢＭＶ）病例分析,总结ＰＢＭＶ术中、术后提高疗效及防止并发症的经验和体会。方法采用Ｉｎｏｕｅ法进行ＰＢＭＶ,并对部分操作技术进行了改进。术后对１１０例病人随访２４±１０个月,观察ＰＢＭＶ术后近期及远期疗效。结果１５２例中１５１例成功,成功率９９５％;长期随访的１１０例患者,７６％心功能稳定于ＮＹＨＡⅠ级,二尖瓣口面积（ＭＶＡ）（２０６±０４０）ｃｍ２,有５３％发生再狭窄,无一例死亡。结论作者认为严格选择病人、熟练地进行房间隔穿刺与球囊扩张、操作人员密切配合及术后预防再狭窄是提高ＰＢＭＶ疗效与避免并发症的关键     

经皮球囊二尖瓣成形术的远期疗效

目的 观察经皮球囊三尖瓣成形术近期及远期疗效.方法 自1992年4月至2008年11月采用Inoue单球囊法对1768例风湿性心脏病二尖瓣狭窄患者行经皮球囊二尖瓣成形术(PBMV)治疗.对其中自1992年4月至1998年8月426例术后10年患者进行随访.球囊扩张前后均采用同步记录左心房和左心室压力,计算二尖瓣跨瓣压差.术前、术后及随访中均采用超声心动图检查和临床心功能评价.结果 1748例完成PBMV治疗,成功率为98.86%.左心房平均压由术前(38±7)mm Hg(1 mm Hg=0.133 kPa)下降至(12±4)mm Hg(P<0.001),二尖瓣平均跨瓣压差由术前(28±6)mm Hg下降至(8±3)mm Hg(P<0.001),二尖瓣口面积由术前(0.98±0.26)cm~2增加至(1.97±0.39)cm~2(P<0.001).主要并发症为死亡2例,急性心包填塞1例,肺水肿1例,重度二尖瓣反流12例,脑栓塞2例.426例PBMV术后10年随访,心功能仍然维持在纽约心功能Ⅰ～Ⅱ级而未冉进行PBMV或换瓣术者288例(67.6%),冉狭窄140例(33.3%),死亡31例(7.5%).结论 PBMV是治疗风湿性心脏病二尖瓣狭窄的有效方法 .     

Utility of the posterior to anterior mitral valve leaflets length ratio in prediction of outcome of percutaneous balloon mitral valvuloplasty

Background: Scoring of mitral stenosis (MS) severity is very important for selection of patients for balloon mitral valvuloplasty (BMV). Objective: We propose a novel yet simple, independent parameter of MS severity based on the posterior mitral valve leaflet to anterior mitral valve leaflet length ratio (PMVL/AMVL length ratio). It could be a useful predictor to outcome of BMV. Subjects and methods: A total of 106 patients (mean age 29.1 ± 8.6 years) had MS with mitral valve score of eight or less. The length of anterior mitral valve leaflet and posterior mitral valve leaflet were measured. Patients were classified into group with ratio ≥ 1/2 and group of ratio <1/2. Eighty‐five healthy control subjects were studied. Results: Patients with PMVL/AMVL ratio ≥ 1/2 post‐BMV had lower transmitral gradients (4.5 ± 3.1 mmHg vs. 9.7 ± 2.1 mmHg, P < 0.002) and greater mitral valve area (MVA) (2.09 ± 0.3 cm² vs. 1.5 ± 0.2 cm², P < 0.001), lower pulmonary artery systolic pressure (PASP) (23.8 ± 14.3 mmHg vs. 34.2 ± 12.5 mmHg, P < 0.001), left atrial pressure (10.2 ± 6.7 mmHg vs. 18.9 ± 6.4 mmHg, P < 0.001), and lower incidence of de novo or worsening of mild mitral regurgitation (MR; 1.64% vs. 8.9%, 0% vs. 6.6%, P < 0.001). PMVL/AMVL length ratio was positively correlated with post‐BMV MVA (r = 0.69, P < 0.002), PASP (r = 0.592, P < 0.003), and negatively correlated with incidence of de novo or worsening of mild MR (r =–0.78, –0.93, P < 0.001). The regression analyses revealed that PMVL/AMVL ratio is the best and a reliable predictor of success and outcome of BMV, hazard ratio (95% confidence interval) 0.12 (0.05–52), P < 0.001. Conclusion: Length ratio of PMVL/AMVL assessment with echocardiography is an excellent simple predictor of post‐BMV mitral valve area and the cardiac events. (Echocardiography 2011;28:1068‐1073)     

Hemodynamic effects and long-term outcome of percutaneous balloon valvuloplasty in patients with mitral stenosis and atrial fibrillation

BACKGROUND: The presence of atrial fibrillation (AF) has been identified as a predictor of a suboptimal result in some patients undergoing percutaneous balloon valvuloplasty in the treatment of symptomatic rheumatic mitral stenosis. HYPOTHESIS: Atrial fibrillation adversely affects the short- and long-term outcome of patients with mitral stenosis undergoing percutaneous balloon valvuloplasty. METHODS: A retrospective chart review of 104 consecutive patients with rheumatic mitral stenosis undergoing percutaneous balloon valvuloplasty was performed. A successful procedure was defined as a final mitral valve area > or = 1.5 cm2 and the absence of a complication. Endpoints included freedom from mitral valve replacement, death, and repeat balloon valvuloplasty at 5 years. RESULTS: A successful procedure was obtained in 89% of patients with sinus rhythm and in 78% of patients with AF (p = NS). Patients in sinus rhythm had a greater cardiac output resulting in a larger final valve area than patients in AF (1.8 vs. 1.6 cm2, p < 0.05). Freedom from valve replacement, death, and repeat balloon valvuloplasty at 5 years was 75% for patients in AF and 76% for patients in sinus rhythm (p = NS). Lower postprocedure mitral regurgitation grade and absence of prior commissurotomy were the only independent predictors of event-free survival. CONCLUSIONS: Patients with mitral stenosis and AF have lower cardiac outputs and gradients than patients with sinus rhythm, despite similar valve areas. The long-term outcome of balloon valvuloplasty is independent of the initial cardiac rhythm.     

Plasma level of soluble P-selectin in patients with rheumatic mitral stenosis and sinus rhythm undergoing percutaneous mitral balloon valvuloplasty

Objective To determine whether plasma level of soluble P-selectin (sP-selectin) increases in rheumatic mitral stenosis (MS) patients with sinus rhythm, who have scheduled for percutaneous mitral balloon valvuloplasty (PMBV), and to examine the effect of PMBV on sP-selectin level. Methods Twenty-six patients with MS and sinus rhythm (study group, 20 female, mean age 33 ± 8 years) and a well-matched control group composed of 21 healthy volunteers (15 female, mean age 35 ± 6 years) were enrolled in the study. In each patient left atrial (LA) thrombus was excluded by transesophageal echocardiography. sP-selectin levels were compared between study patients and controls, and between peripheral and LA blood. Changes in sP-selectin level 24 h and 4 weeks after PMBV were also analyzed. Results A significantly higher basal sP-selectin level was noted in study group. After PMBV, the mitral valve area (MVA) increased and the transmitral mean gradient decreased significantly. At 24th hour after PMBV, sP-selectin level decreased from 1080.38 ± 143.87 ng/ml to 960.00 ± 103.26 ng/ml (p < 0.0001) and at 4th-week follow-up it was decreased from 960.00 ± 103.26 ng/ml to 879.61 ± 98.16 ng/ml (p < 0.0001). No significant difference was found between peripheral and LA blood regarding the sP-selectin level. Correlation analysis between the difference in MVA measured 24-hour after and before PMBV and the difference in sP-selectin level measured 24-hour after and before PMBV showed a significant direct relationship between these variables. Conclusion This study suggests that in patients with MS and sinus rhythm sP-selectin level increases probably due to turbulent flow across the stenotic valve. After PMBV sP-selectin shows a progessive decline, which is directly correlated with the increase in MVA.     

Successful balloon dilatation of both orifices in a case of double‐orifice mitral valve with severe rheumatic stenosis

A 24‐year‐old female patient presented to us with progressive dyspnea on exertion for last three year. She was not a known case of rheumatic heart disease. Her physical examination showed regular pulse and her blood pressure was 100/76 mm Hg. Cardiac palpation showed grade 3 parasternal heave and auscultation revelled an accentuated first heart sound, loud P2 and mid‐diastolic long rumbling murmur at apex and pansystolic murmur of tricuspid regurgitation at lower left sterna border. Chest X‐ray showed evidence of grade 3 pulmonary venous congestion. Transthoracic and transesophageal two‐dimensional echocardiography revealed a double‐orifice mitral valve of complete bridge type at the leaflet level. Both orifice sizes were unequal, with the anterolateral orifice being smaller than its counterpart. There was moderate subvalvular fusion and both commisures were fused. Color doppler examination showed two separate mitral diastolic flows with mean gradients of 22 mm and 20 mm of Hg, respectively. There was no mitral regurgitation and no left atrial or appendage clot was seen by transesophageal echocardiography. Transseptal puncture was done by the modified fluoroscopic method. Posteromedial orifice was crossed with a 24 mm Inoue balloon and dilated using the stepwise dilation technique. Anterolateral orifice was not crossed by Inuoe balloon after multiple attempts. A TYSHAK (NuMAD Canada Inc.) balloon (16 × 40mm) was taken over the wire and inflated successfully across the anterolateral orifice with the help of transthoracic echocardiography guidance. Mean gradient become 9 and 8 mm across the medial and lateral orifice. Patient was discharged in stable condition after two day. © 2015 Wiley Periodicals, Inc.     

Successful percutaneous mitral balloon commissurotomy in a patient with a previous mitral valve repair

A case of successful percutaneous mitral balloon commissurotomy (PMBC) in a patient who had undergone mitral valve repair with a Carpentier ring 6 years earlier is described. © 1993 Wiley-Liss, Inc.     

老年二尖瓣狭窄患者经皮球囊二尖瓣成形术的探讨

目的探讨老年二尖瓣狭窄患者接受经皮球囊二尖瓣成形术(PBMV)的疗效和安全性。方法观察同期行PBMV的65例(年龄≥60岁)老年二尖瓣狭窄患者(老年组)和516例青壮年二尖瓣狭窄患者(青壮年组)的疗效和安全性。结果老年二尖瓣狭窄患者与青壮年二尖瓣狭窄患者接受PBMV的疗效和安全性相当;老年患者PBMV后二尖瓣再狭窄发生率显著低于青壮年(P<0.05)。结论老年二尖瓣狭窄患者和青壮年二尖瓣狭窄患者一样接受PBMV治疗安全、有效,且不易发生二尖瓣再狭窄。     

风湿性心脏病二尖瓣狭窄患者球囊扩张术后6个月疗效观察

目的　评价经皮二尖瓣球囊扩张术 (PBMV)在老年及瓣膜钙化程度重的患者中的 6个月效果。　方法　选择我院行PBMV患者 6 82例 ,以血液动力学评价术前及术后即刻左房压、肺动脉平均压、二尖瓣跨瓣压差及二尖瓣瓣口面积 ;超声心动图评价术前和术后 6个月二尖瓣口面积及跨瓣压差。　结果　PBMV有效缓解二尖瓣口的机械性狭窄 ,引起左房压、二尖瓣跨瓣压 ,肺动脉压力下降及二尖瓣口面积 (MVA)增加 ,两组患者均获益 ,老年组分别平均下降 (9 1± 1 1)mmHg、(10 9± 2 2 )mmHg、(9 1± 1 5 )mmHg、MVA增加 (0 5 2± 0 16 )cm2 ;非老年组分别为 (8 9± 2 4 )mmHg、(7 3± 0 8)mmHg、(7 3± 2 3)mmHg、MVA增加 (0 6 6± 0 11)cm2 。超声随访结果显示 ,PBMV疗效稳定。　结论　PBMV较为明显的改善二尖瓣狭窄症状 ,具有微创、低风险的特点。适用于瓣膜钙化重、条件差和高危围术期而不适合二尖瓣置换术的老年患者。     

Unusual tear in inoue balloon during percutaneous balloon mitral valvuloplasty in a patient with calcific mitral stenosis

An unusual tear in an Inoue balloon during dilatation of calcific mitral stenosis is presented and its mechanisms discussed. An abnormal sequence of inflation indicates a possible tear.