PTF—V1在二尖瓣狭窄球囊扩张术中的临床效果分析

目的 探讨二尖瓣狭窄患者行经皮二尖瓣球囊扩张术（ＰＢＭＶ０前后心电图ＰＴＦ－Ｖ１的变化及其与血流动力学各指标的相关性。方法 分析２９例窦性心律的二尖瓣狭窄患者ＰＢＭＶ前后ＰＴＦ－Ｖ１的变化,并与二尖瓣面积（ＭＶＡ）、左房平均压（ＭＬＡＰ）和左房内径（ＬＡＤ）作相关分析。结果 ＰＢＭＶ术后ＰＴＦ－Ｖ１显著改善（Ｐ〈０．０１）,与ＭＬＡＰ、ＬＡＤ呈显著正相关,与ＭＶＡ呈显著负相关（Ｐ〈０．０５）。结论     

PtfV1对二尖瓣球囊扩张术疗效的评价

为了探讨风湿性心脏病二尖瓣狭窄患者经皮二尖瓣球囊成形术（ＰＢＭＶ）前后心电图ＰｔｆＶ１的改变与疗效的关系，本文分析了２１０例窦性心律的二尖瓣狭窄ＰＢＭＶ前后ＰｔｆＶ１的变化，并与血流动力学和心脏Ｂ超的有关参数作用相关性研究，结果：ＰｔｆＶ１术前为－０．０８７±０．０３／ｍｍ，ｓ，术前－０．０４２±０．０２７／ｍｍ．ｓ（Ｐ〈０．０１），ＰＢＭＶ前后ＰｔｆＶ１的改变与平均左房压（ＭＬＡＰ），二尖瓣跨瓣     

二尖瓣狭窄伴心房颤动球囊成形术前抗凝及术后复律的探讨

风湿性心脏病 (简称风心病 )二尖瓣狭窄 (ＭＳ)伴心房颤动(Ａｆ)的患者 ,在经皮二尖瓣球囊成形术 (ＰＢＭＶ)后进行Ａｆ复律对改善心功能、减少血栓形成及栓塞并发症的发生有重要作用。关于ＭＳ合并Ａｆ患者行ＰＢＭＶ术前的抗凝时间问题尚无一致标准[1] ,对于ＰＢＭＶ术后Ａｆ的转复时机及方式亦有较多报道[2 ,3 ] 。本文对我院 2 2例ＭＳ合并Ａｆ患者给予低分子量肝素 (ＬＭＷＨ)短期抗凝后行ＰＢＭＶ ,在ＰＢＭＶ术后即刻给同步直流电复律 ,旨在探讨ＭＳ合并Ａｆ患者在ＰＢＭＶ术前的抗凝时间 ,术后Ａｆ的转复时机及窦性心律的药物维持等…     

经皮二尖瓣球囊扩张术近期血流动力学改变及相关性分析

目的了解经皮二尖瓣球囊扩张术（ＰＢＭＶ）近期血流动力学改变规律和相互关系，从而指导ＰＢＭＶ操作的改进。方法对５５例二尖瓣狭窄患者，于术前、术后１周内均行超声心动图检查测量二尖瓣口面积（ＭＶＡ）、左房内径（ＬＡＤ）和肺动脉平均压（ＰＡＰ多谱勒法），术中常规检测扩张前后的左房平均压（ＬＡＰ）和肺动脉平均压（ＰＡＰ导管法）。结果ＰＢＭＶ术后，ＭＶＡ显著增加（Ｐ＜０．０５），增加幅度为（０．６８±０．３１）ｃｍ２，增加率为（６９．３±４０．７）％；ＬＡＰ显著降低（Ｐ＜０．０５），降低幅度为（３７．５±１６．８）％；ＰＡＰ（导管法）、ＰＡＰ（多普勒法）、ＬＡＤ与术前相比差别无显著性。相关分析可知，ΔＭＶＡ和ΔＬＡＰ存在相关关系；导管法、多普勒法测定的ＰＡＰ之间也存在相关关系。结论由术中ΔＬＡＰ可推断ΔＭＶＡ，ΔＬＡＰ可反映ＰＢＭＶ的效果。本研究结果中使ＰＢＭＶ效果的判断更简便，具有临床实用价值。     

PBM V对血浆降钙素基因相关肽水平的影响

目的：评价血浆降钙素基因相关肽（ＣＧＲＰ）含量与肺循环血流动力学、心房纤颤（简称房颤）之间关系及经皮球囊二尖瓣成形术（ＰＢＭＶ）对ＣＧＲＰ含量的影响。　方法：２８ 例风湿性二尖瓣狭窄行ＰＢＭＶ 的患者,按有无房颤分为窦性心律组（Ａ组, １４ 例）和房颤组（Ｂ组, １４例）。利用ＰＢＭＶ前后心导管和超声心动图检查,测量平均肺动脉压（ＭＰＡＰ）,平均左房压（ＭＬＡＰ）,左房内径（ＬＡＤ）和瓣口面积（ＭＶＡ）。ＰＢＭＶ前、后即刻和１ 周分别抽血测血浆ＣＧＲＰ含量。　结果：ＰＢＭＶ前、后两组患者血浆ＣＧＲＰ含量差异不显著,ＰＢＭＶ后两组患者血浆ＣＧＲＰ明显升高;相关分析表明,ＣＧＲＰ含量与ＭＰＡＰ、ＭＬＡＰ、心功能指数呈负相关。　结论：ＣＧＲＰ含量不足可能参与二尖瓣狭窄的肺循环血流动力学的病理生理改变及心功能不全的发病过程。     

重度二尖瓣狭窄小球囊成形术前后的超声评价

目的：探讨彩色多普勒超声心动图在重度二尖瓣狭窄（ＭＳ）行小球囊经皮二尖瓣球囊成形术（ＰＢＭＶ）前后的作用。方法：观察２２例重度ＭＳ行小球囊ＰＢＭＶ前后的超声心动图变化。结果：术后超声心动图发现左房内径、二尖瓣口面积较术前显著改善（Ｐ〈０．００１），而二尖瓣返流无显著增加。结论：重度ＭＳ行小球囊ＰＢＭＶ，疗效满意，Ｗｉｌｋｉｎｓ超声评分对术前选择扩张球囊的大小有帮助，超声心动图对术后ＭＲ的评价具有重     

重度二尖瓣狭窄小球囊成形术前后的超声评价

目的：探讨彩色多普勒超声心动图在重度二尖瓣狭窄（ＭＳ）行小球囊经皮二尖瓣球囊成形术（ＰＢＭＶ）前后的作用。方法：观察２２例重度ＭＳ行小球囊ＰＢＭＶ前后的超声心动图变化。结果：术后超声心动图发现左房内径、二尖瓣口面积较术前显著改善（Ｐ＜０００１），而二尖瓣返流无显著增加。结论：重度ＭＳ行小球囊ＰＢＭＶ，疗效满意，Ｗｉｌｋｉｎｓ超声评分对术前选择扩张球囊的大小有帮助，超声心动图对术后ＭＲ的评价具有重要的价值。     

双瓣替换术中保留二尖瓣全瓣下结构对左心功能的影响

目的：评价保留二尖瓣全瓣下结构对双瓣替换者术后左心功能的影响。方法：１９例风心病患者行二尖瓣及主动脉瓣双瓣替换术时保留二尖瓣全瓣下结构（Ａ组），同期３７例作常规双瓣替换术（Ｂ组），监测Ａ、Ｂ两组术后血流动力学及左心功能指标。结果：Ａ组术后心排指数、每搏指数和左室收缩功指数显著优于Ｂ组（Ｐ＜０．０５）。术后超声心动图显示Ａ组左室内径、左室功能较Ｂ组改善显著（Ｐ＜０．０５）。结论：双瓣替换术中保留二尖瓣全瓣下结构有利于改善双瓣替换术后左心功能     

超声心动图对风心病二尖瓣狭窄球囊成形术前后血流动力学的观察

对４０例风心病二尖瓣狭窄（ＭＳ）患者行球囊成形术（ＰＢＭＶ）前后做超声心动图（ＵＣＧ）检查,对比其血流动力学变化,结果显示：ＰＢＭＶ术后二尖瓣平均跨瓣压差（ＰＧｍｅａｎ）由（２２３±１１６）ｋＰａ降低为（０７９±０３７）ｋＰａ（Ｐ＜０００１）;二尖瓣口面积（ＭＶＡ）由（０９０±０２５）ｃ增加为（１８６±０８８）ｃ（Ｐ＜０００１）;射血分数（ＥＦ）由０５３±００６增加为０６８±００４（Ｐ＜０００１）;左房平均压（ＬＡＰ）由（３７３±１１９）ｋＰａ降低为（１８２±０６８）ｋＰａ（Ｐ＜０００１）;ＬＡＰ降低率与ＰＧｍｅａｎ降低率,ＭＶＡ增加率、ＥＦ增加率呈正相关关系（Ｐ＜００１）。结论：ＵＣＧ可作为全面评价ＰＢＭＶ疗效的简便有效、直观可靠的手段     

二尖瓣闭式分离术后再狭窄的经皮球囊成形术疗效观察

目的：研究闭式分离术后再狭窄患者经皮二尖瓣球囊成形术（ＰＢＭＶ）治疗近期和远期疗效及其影响因素。　方法：对经ＰＢＭＶ治疗的二尖瓣闭式分离术后再狭窄患者３３ 例与无外科手术史的二尖瓣狭窄患者（３１３ 例）进行比较,并随访观察。　结果：ＰＢＭＶ治疗后临床症状明显改善,二尖瓣外科术后再狭窄患者瓣口面积（ＭＶＡ）由（１．０３±０．２８）ｃｍ ２ 增至（１．９４±０．２７）ｃｍ ２ （Ｐ＜ ０．００１）,原发性二尖瓣狭窄者瓣口面积由（１．１２±０．４５）ｃｍ ２ 增至（２．２２±０．２６）ｃｍ ２ （Ｐ＜ ０．００１）,血流动力学两组无显著差异。其中１９例随访（４．３±２．１）年,ＭＶＡ 为（１．８１±０．２７）ｃｍ ２（与术前比较,Ｐ＜ ０．００１,与术后即刻比较,Ｐ＞ ０．０５）,发生再狭窄３例,已成功行第二次ＰＢＭＶ。　结论：ＰＢＭＶ治疗闭式分离术后再狭窄近期、远期疗效显著,具有创伤小、安全、有效、可重复性的特点,可避免或推迟外科手术。     

Role of closed mitral commissurotomy for mitral restenosis

Out of 1184 consecutive cases of rheumatic mitral stenosis treated surgically by closed mitral commissurotomy (CMC) at NRS Medical College and Hospital, Calcutta, 20 (1.68%) were mitral valve restenosis. Twelve cases (60%) were females, The median age was 32 years. Duration between the first operation and reappearance of symptoms varied with a mean of 8 years. The previous operations were digital dilatation and instrumental dilatation in 6 and 14 cases respectively. History of thromboembolism was present in 4 cases. On echocardiography, calcification of the mitral valve was present in 2 cases, left atrial clot in 4 cases, associated mild to moderate mitral regurgitation in 6 cases and mild aortic regurgitation in 4 cases. All cases presented with New York Heart Association (NYHA) III and IV symptoms. Critical stenosis (mitral valve orifice less than 0.5 cm2) was present in 12 cases. Re-do CMC was undertaken in all cases with Tubb's dilator. Median operating time was 2.5 hours. Satisfactory split was achieved in 13 cases. One patient died during surgery. Four cases having less than satisfactory split were asymptomatic on follow-up. In one case no split was possible and in another, gross mitral regurgitation was noted postoperatively. These 2 cases had to undergo open heart surgery. It is concluded that re-do CMC is a feasible and suitable alternative in mitral restenosis even in the presence of complications.     

二尖瓣成形术治疗二尖瓣关闭不全的临床研究

目的总结25例二尖瓣关闭不全患者行二尖瓣成形术的手术方法及效果。方法患者均在全麻低温体外循环下施行,采用瓣叶切除修复、瓣裂修复、交界缝合、腱索缩短、双孔二尖瓣成形、人工瓣环植入。手术前、后应用食道内超声心动图判断二尖瓣反流的原因和部位及手术治疗效果,术中采用左室注水加压试验初步判断二尖瓣成形的效果。术后随访主要依靠超声心动图。结果围术期死亡1例,死于恶性心律失常。术后心脏彩超显示,15例(60.00%)无二尖瓣返流,9例(36.00%)为轻微～轻度返流,左房、左室较术前明显缩小,心功能较术前明显改善。结论严格掌握手术适应征,针对不同瓣膜病变,运用合理的瓣膜成形技术,行二尖瓣外科修复疗效确切,术中左室注水试验及经食道超声心动图可为二尖瓣成形提供良好的技术支持。     

“钮扣状”转移保留二尖瓣全装置瓣膜置换的初步探讨

目的 :探讨二尖瓣狭窄病人采用“钮扣状”转移保留全瓣装置二尖瓣置换的方法及对左心功能的影响。方法 :对 5 6例二尖瓣狭窄需行二尖瓣置换的患者 ,分为 :A组 (术中“钮扣状”保留全部二尖瓣瓣下结构 ) ,B组(术中仅保留二尖瓣后瓣及瓣下结构 )和C组 (术中未保留瓣下结构 ) ;于术前 ,术后监测血流动力学指标 ;术前、术后出院前、术后 3～ 6个月行超声心动图检查 ,监测心功能指标。结果 :A组术后心排指数、每搏指数、左室收缩功指数、肺毛细血管楔压、左室舒张末、收缩末内径、左室射血分数、短轴缩短率及左室长轴舒张末内径均优于B ,C组 ,且EF值恢复优于B ,C组。A组主动脉阻断时间较B ,C组延长 ,但总转流时间比较 ,差异无显著性 (P >0 .0 5 )。结论 :以二尖瓣狭窄为主的病人行瓣膜置换时可采用“纽扣状”转移保留全部瓣下装置 ;病人术后早期心功能的改善优于部分保留组和不保留组。     

142例二尖瓣关闭不全患者行二尖瓣修复成形术的手术经验

目的　分析、总结 14 2例行二尖瓣修复成形术的二尖瓣关闭不全患者的临床疗效。方法　 1994年 1月～ 2 0 0 3年 12月 ,连续对 14 2例二尖瓣关闭不全患者行修复成形术 ,男 88例 ,女 5 4例 ,平均年龄为 (38.5± 7.8)岁。病因诊断 :二尖瓣腱索断裂 74例 ,二尖瓣黏液变性伴瓣叶脱垂 36例 ,冠心病二尖瓣乳头肌功能不全15例 ,二尖瓣瓣环扩大 11例 ,感染性心内膜炎伴二尖瓣穿孔 4例 ,扩张型心肌病伴二尖瓣关闭不全 2例 ;7例患者合并非风湿性主动脉瓣病变。手术在体外循环、中低温下施行 ,采用瓣叶切除缝合、瓣环成形、穿孔修补、腱索转移、edgetoedge技术及人工腱索成形技术 ,术中以食道超声监测成形效果。 结果　死亡 2例 ,1例术后第 6天死于脑出血 ,另 1例术后第 5天死于多器官功能衰竭。 5例患者术中转为瓣膜置换手术 ;其余患者术毕二尖瓣无返流或轻度返流。在平均为 (34.5± 4 .8)个月的随访中 ,有 2例二尖瓣返流加剧至中度而行二尖瓣置换手术。其余患者二尖瓣返流未见加剧 ,心功能恢复良好。结论　选择适当的患者、运用合理的瓣膜成形技术 ,二尖瓣关闭不全患者行瓣膜成形术可取得满意的疗效。     

“钮扣状”转移保留二尖瓣全装置瓣膜置换的初步探讨

OBJECTIVE: To evaluate the surgical technique and the effect of preservation of the entire mitral subvalvular apparatus during mitral valve replacement (MVR) in patients with mitral stenosis. METHODS: MVR was performed on 56 patients with mitral stenosis. Of them, 11 had complete preservation of the entire mitral subvalvular apparatus (group A) with the technique of preservation of 'button-shaped' transplantation, 25 had the preservation of the posterior leaflet only (group B), and the other 20 underwent the conventional MVR (group C). Pre- and postoperative hemodynamic parameters were measured to determine the left ventricular performance. Echocardiography was performed preoperatively, at the time of discharge, and 3 to approximately 6 months postoperatively to determine the dimensions and ejection function. RESULTS: Cardiac index, stroke volume index and left ventricular stroke work index postoperatively in group A were better than those in group B and C (P < 0.05). Echocardiographic measurements postoperatively showed the increase of LVESD, LVEDD in group B and C, but a better LVL and LVFS in group A (P < 0.05), and LVEF was more pronounced in group A (P < 0.05). There appeared a long cross-clamp time in group A, but the total CPB time was not significant among the three groups. CONCLUSION: The surgical skills of preservation with 'button-shaped' transplantation may be a practical choice for patients with mitral stenosis. The preservation of entire mitral subvalvular apparatus improves the left ventricular functions after MVR in patients with mitral valve stenosis.     

A comparative study of balloon mitral valvuloplasty and closed mitral commissurotomy in patients with rheumatic mitral stenosis

Rheumatic mitral stenosis is frequently encountered in our country. It affects younger population and is a major cause of morbidity Mitral valvotomy is the definitive therapy for this disease and can be achieved by closed mitral commissurotomy (CMC), open mitral commissurotomy (OMC) or by percutaneous transluminal mitral valvuloplasty (PTMV). Compared to CMC, PTMV is less invasive but more expensive at this moment. With the reduction of cost, PTMV may become the procedure of choice for the treatment of rheumatic mitral stenosis in future.     

Non-surgical mitral valvotomy

Percutaneous transseptal mitral valvotomy was performed on 14 occasions in 13 patients; in one patient, the procedure was unsuccessful at the first attempt, but was repeated successfully. All other attempts were successful, giving a procedure success rate of 93% and a patient success rate of 100%. The only complication was transient diplopia in one patient, presumably due to a small cerebral embolus. This early experience confirms that this procedure is easily learnt, and can be performed with good results and low risk in selected patients with mitral stenosis.