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。     

Angiographic recognition of a proximal balloon tear during inoue balloon mitral valvotomy

Two patients in whom a proximal balloon tear accompanied by a unique angiographic appearance occurred during percutaneous balloon mitral valvotomy using the Inoue balloon catheter are described.     

经皮二尖瓣扩张术治疗老年及老年前期患者二尖瓣狭窄

目的　探讨经皮经房间隔穿刺二尖瓣扩张治疗老年和老年前期患者二尖瓣狭窄的临床意义。方法　 86例患者采用一步法经皮经房间隔穿刺球囊扩张治疗二尖瓣狭窄。手术前后分别记录右心房压、左心房压、肺动脉压 ,二尖瓣口面积 ,并进行手术后随防。结果　 86例患者中 83例治疗成功 ,3例失败 ,其中 1例为术中急性心包填塞 ,2例术后出现中度二尖瓣反流。术后即刻 ,左心房压、肺动脉压下降 ,二尖瓣口面积增加 ,心功能改善。 4 2例患者随访(4 .4± 2 .1)年 ,1例出现再狭窄 ,1例原因不明猝死 ,1例因二尖瓣反流行瓣膜置换术 ,其余患者心功能和生活质量明显改善。结论　对年龄≥ 5 0岁伴轻度二尖瓣和 (或 )主动脉瓣反流 ,瓣膜钙化或瓣下结构病变的二尖瓣狭窄患者 ,可安全有效地施行球囊二尖瓣成形术。     

二尖瓣球囊成形术长期随访结果

目的 :随访经皮二尖瓣球囊成形术 （PBMV）治疗风湿性二尖瓣狭窄长期疗效。方法 :采用 Inoue单球囊扩张狭窄的二尖瓣 ,对 PBMV术患者 2 2 7例进行追踪随访 ,评价临床心功能和瓣口状况。平均随访时间 （6 .3± 2 .1）年。结果 :PBMV术后二尖瓣口面积 （MVA ）显著扩大 ,从 （1.0 1± 0 .2 8） cm 2扩至 （2 .34± 0 .17） cm2 （P<0 .0 1） ,长期随访 ,MVA逐渐减小至 （1.6 6± 0 .37） cm2 （P<0 .0 1）。再狭窄率为 2 2 .9%。二尖瓣跨瓣压差 （MVG）从 （19.5± 6 .2 ）mm Hg分别减少至术后、随访的 （7.4± 5 .1）和 （10 .1± 4.9） m m Hg,差别显著 （P<0 .0 1）。随访中临床心功能改善仍然维持 1个级别以上者达 77.1%。随访射血分数 （EF）变化不大、二尖瓣返流 （MR）较术前、后明显加重 （P<0 .0 1）。结论 :PBMV治疗二尖瓣狭窄长期临床疗效良好     

经皮球囊二尖瓣扩张术后再狭窄及远期疗效

目的对经皮二尖瓣球囊扩张术（ＰＢＭＶ）后病人长期随访资料作了回顾性分析，以确定再狭窄率、远期疗效及其影响因素。方法对１９８６年５月～１９９５年１２月随访资料完整的１６０例患者进行了回顾性研究，其中男５５例，女１０５例，年龄３８９±８９岁。随访时间１２～８１个月，平均３６±１５个月。对影响远期疗效的因素，用Ｃｏｘ风险模型作了分析。结果随访期间，１２７例（７９％）心功能持续改善。超声心动图测得的术前、术后及随访的二尖瓣口面积分别为１１５±０２ｃｍ２、２１５±０４ｃｍ２和１９２±０４ｃｍ２。２６例（１７％）发生再狭窄，其中１７例症状复发。结论ＰＢＭＶ术后可保持较好的远期疗效，平均３６个月的再狭窄率为１７％。术前超声心动图计分、心功能、有无心房颤动和左房压为长期疗效的独立预测因素。     

Percutaneous transvenous mitral commissurotomy using the inoue balloon catheter

Since its inception in 1982, percutaneous transvenous mitral commissurotomy (PTMC) with the Inoue balloon catheter has gained increasingly wide use internationally. The procedure is technically successful in over 90% of patients, and the long-term durability of commissurotomy is excellent in those with pliable mitral valve leaflets and minimally deformed submitral apparatus. PTMC offers an alternative to patients previously not considered candidates for surgery, where no alternative had existed in the past. After transseptal puncture, PTMC using the Inoue balloon can be accomplished easily in the majority of patients. In comparison to double balloon mitral valvotomy, the postdilatation valve area is similar, the incidence of mitral regurgitation is not different, and the fluoroscopic and procedure time are markedly shorter. While patients with little valve deformity are excellent candidates for this procedure, and those not considered candidates for surgical therapy are also easily defined, selection of patients for balloon dilatation among those with significant valve deformity who are otherwise candidates for valve replacement therapy remains a challenging problem. © 1993 Wiley-Liss, Inc.     

分级次二尖瓣球囊扩张预防二尖瓣反流的初步研究

目的为探讨经皮穿刺球囊导管二尖瓣扩张术（ＰＢＭＶ）引起二尖瓣反流（ＭＲ）的原因及其预防方法。方法我们采用分级次扩张法和改良Ｉｎｏｎｅ法对人体病变二尖瓣和硅胶二尖瓣模型进行体外球囊导管扩张实验，并对１３２例风湿性心脏病重度二尖瓣狭窄患者，其中分别以分级次扩张法９６例，Ｉｎｏｎｅ法３６例进行ＰＢＭＶ的前瞻性对比研究。结果（１）ＰＢＭＶ引起二尖瓣反流的原因除与瓣膜钙化程度重、瓣下结构紊乱有关以外，瓣口面积小、交界粘连处夹角小是一个重要原因。（２）分级次扩张可使交界粘合处夹角呈渐进性扩大，扩张时不易引起瓣膜撕裂和二尖瓣反流。两组比较Ｉｎｏｎｅ法扩张组二尖瓣反流发生率为１６．７％，分级次扩张组无二尖瓣反流病例，并且术中其他并发症及术后再狭窄发生率后者也明显低于前者。结论球囊导管分级次扩张可有效地预防二尖瓣反流，是治疗二尖瓣狭窄较理想的方法。     

老年风湿性心脏病患者经皮二尖瓣球囊成形术21例分析

目的评估经皮二尖瓣球囊成形术（ＰＢＭＶ）治疗老年人风湿性心脏病的疗效。方法分析老年风湿性心脏病二尖瓣狭窄患者行ＰＢＭＶ术前、术后超声心动图、血流动力学指标及心功能状况。结果２１例行ＰＢＭＶ，２０例成功，成功率９５．２％；未发生严重并发症，仅１例因瓣膜明显均质性致密增厚而扩张失效。平均随访９±３个月，ＰＢＭＶ术后二尖瓣口面积从１．１２±０．２５ｃｍ２增加至１．８９±０．２７ｃｍ２，左房平均压从３．４０±１．０８ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）降至１．７２±０．７５ｋＰａ，术后心功能改善１级者６例，改善２级及以上者１４例，手术失败１例心功能无改善。结论ＰＢＭＶ是老年风湿性心脏病二尖瓣狭窄患者安全、有效的治疗措施之一。     

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.     

15例二尖瓣狭窄患者球囊二尖瓣成形术的临床观察

本文对１５的二尖瓣狭窄患者，经皮球囊二尖瓣成形术（ＰＢＭＶ）的效果及随访进行了观察。用日本ＩＮＯＵＥ和广东省医院制球囊导管，按常规方法在Ｘ线透视下，借助Ｂ超协助定位，术中进行持续压力监测及Ｂ超监测。术后随访一年半，观察Ｂ超、胸片、心电图等。１５例患者中，除１例因左房导丝（ＴＭＣ）脱位外，其余１４例成功。二尖瓣口面积由０．８２±０．１５ｃｍ２增至１．６９±０．３４ｃｍ２，左房容积缩小，二尖瓣跨瓣压差减少，肺动脉压下降，心尖区舒张期杂音明显减轻，术后恢复较好。经常规抗风湿治疗，无一例发生再狭窄。作者认为只要严格掌握适应证及防治风湿活动，ＰＢＭＶ在临床上是一有效的治疗方法。     

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。     

Neuro-embolic protection during percutaneous balloon mitral valvuloplasty.

This report describes the management of a patient with severe symptomatic mitral stenosis and a large mobile thrombus extending from the left atrial appendage that was resistant to warfarin therapy. Percutaneous balloon mitral valvuloplasty was performed with cerebral protection using bilateral internal carotid artery filters to minimize the risk of embolic stroke.     

79例经皮球囊二尖瓣成形术患者10年远期疗效评价

目的评价二尖瓣球囊成形术（ＰＢＭＶ）后１０年以上的远期疗效。方法对７９例ＰＢＭＶ患者进行严格的术后追踪随访,包括超声心动图和临床心功能评价。平均随访时间（１１．２±１．１）年。结果ＰＢＭＶ术后二尖瓣口面积（ＭＶＡ）显著扩大,为（１．０９±０．３２）ｃｍ２与（２．０４±０．４３）ｃｍ２,Ｐ＜００１;随访１０年,ＭＶＡ逐渐减小至（１．４７±０．３６）ｃｍ２,Ｐ＜０．０１;再狭窄率为３９．２％。ＰＢＭＶ术后心功能改善１个级别以上者占９７．５％。术后１０年随访心功能仍然维持在Ⅰ～Ⅱ级而未再次行介入或心脏手术者占７７．２％。术后新出现或轻度加重的二尖瓣反流以及新出现的房间隔分流分别为１２．６％和７．９％,均未引起明显的血流动力学障碍,长期保持良好的心功能。结论ＰＢＭＶ术后１０年以上临床远期疗效良好,未见严重并发症。     

Percutaneous mitral balloon valvuloplasty in pregnant women with mitral stenosis.

Forty-four consecutive pregnant patients with mitral stenosis were submitted to percutaneous mitral valvuloplasty (PMV) over a period of 12 years. The mean age was 28 +/- 6 years and the mean gestational age was 23 +/- 6 weeks. The mean mitral valve area had a significant increase from 1.17 +/- 0.26 to 2.06 +/- 0.41 cm(2) (P = 0.0000). The mean mitral valve gradient decreased from 16.22 +/- 5.55 to 7.94 +/- 3.75 mm Hg (P = 0.0001). The procedure was performed successfully in 95% of the patients and there were no major complications. Concerning labor and delivery, we evaluated 37 patients. Thirty patients (81%) reached term and delivered normal infants. Seven patients (18.9%) delivered prematurely, resulting in two fetal death; one patient delivered a stillborn. We concluded that PMV is a safe procedure for the treatment of mitral stenosis in pregnant patients, providing significant symptomatic relief and better clinical conditions for labor and delivery.     

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.     

Coronary arterial embolism due to valvular debris after percutaneous valvuloplasty of calcific mitral stenosis

A 74-year-old woman with refractory congestive heart failure due to long-standing calcific mitral stenosis who refused surgical intervention was treated with percutaneous balloon valvuloplasty. After an uneventful procedure, hemodynamic results were satisfactory with an increase in the mitral valve area from 0.4 to 1.1 cm2. Five hours after the procedure, the patient had a bout of vomiting followed by pulmonary aspiration. Electrocardiography, and in the further course, creatine kinase MB elevation, showed anterior myocardial infarction. Necropsy disclosed embolic material in the mid left anterior descending artery which unequivocally consisted of valvular material. This case demonstrates embolism of valvular debris as a life-threatening, procedure-related complication of percutaneous valvuloplasty of calcific mitral stenosis.     

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。     

Retrograde nontransseptal balloon mitral valvuloplasty using a modified inoue balloon catheter

Retrograde nontransseptal balloon mitral valvuloplasty, a method developed in our institution for the treatment of symptomatic mitral stenosis, avoids transseptal catheterization. Until recently, the self-positioning Inoue balloon catheter, unlike all other commercially available balloon catheters, had not been employed in this nontransseptal technique due to the short length of its catheter shaft. To employ a self-positioning balloon in retrograde nontransseptal balloon mitral valvuloplasty, we modified the Inoue device by extension of the catheter shaft. After retrograde nontransseptal left atrial catheterization using a steerable cardiac catheter, the modified Inoue balloon catheter was inserted through the femoral artery and advanced to the mitral valve retrogradely. Valvuloplasty was performed in 20 patients, with a successful result achieved in all. The modified Inoue balloon catheter was easy to use in retrograde nontransseptal balloon mitral valvuioplasty and showed excellent stability during inflation. Mean mitral valve area increased from 1.0 ± 0.29 to 2.23 ± 0.64 cm² (P<0.001) and mean transmitral gradient decreased from 11.4 ± 6 to 4.3 ± 2.1 mm Hg (P<0.001). No major or minor complications were observed. Retrograde nontransseptal balloon mitral valvuloplasty using a modified Inoue balloon catheter is a feasible and effective technique for the treatment of symtomatic mitral stenosis. It appears to combine the advantages of avoiding transseptal catheterization with the advantages of this balloon's special configuration. © Wiley-Liss, Inc.     

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。     

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