风湿性二尖瓣狭窄患者经皮球囊二尖瓣成形术后的康复医疗

自1992年以来，我们对风湿性二尖瓣狭窄（MS）患者施行经皮球囊二尖瓣成形术（PBMV）共79例，为探讨PBMV术后最佳康复医疗方案，尤其是是对手术并发症的康复医疗处置，以期最大限度地改善患者的功能，现总结报告如下。1资料与方法1．1一般资料本组79例，男24例，女55例，年龄21     

经皮球囊导管二尖瓣成形术治疗风湿性二尖瓣狭窄的长期随 …

目的 评价经皮球囊导管二尖瓣成形术（ＰＢＭＶ）治疗风湿性二尖瓣狭窄（ＭＳ）的远期疗效。方法 自１９８９年５月至１９９７年１２月对风湿性ＭＳ３３６例患者采用Ｉｎｏｕｅ法行ＰＢＭＶ,对成功的３３０例进行８年的随访,每年随访１次,根据临床症状,心尖部期杂音及第一心音的强度改变、心功能、二维及多普勒超声心动图检测的二尖瓣口面积判断远期疗效。随访时二尖瓣口面积经ＰＢＭＶ后增加的面积缩小５０％以上为再狭窄。结     

二尖瓣环大小和运动幅度对球囊扩张术疗效的影响

前瞻性观察二尖瓣环大小及运动幅度对经皮二尖瓣球囊扩张术（ＰＢＭＶ）疗效的影响,结果：风心病二尖瓣狭窄组的二尖瓣环直径较正常对照组明显增大,瓣环在心动周期中的变化值,变化率及位移较正常对照组明显减少,风心病二尖瓣狭窄患者瓣膜超声评分〉８分组≤８分线比较,瓣环较小,瓣环的变化值,变化率及位移明显降低,术后疗效满意组的二尖瓣环大小及运动幅度均大于非满组,１９个相关因素多元逐步回归分析表明,二尖瓣环直径和     

改良经皮二尖瓣球囊成形术治疗二尖瓣狭窄300例疗效观察

由Ｉｎｏｕｅ〔１〕首先报道的经皮穿刺二尖瓣球囊成形术（ＰＢＭＶ）在二尖瓣狭窄的治疗中取得了良好的疗效,目前已广泛应用于临床。但根据全国近１０年的统计资料分析〔２〕,该手术各种并发症的总发生率为９．１％,其中严重并发症的发生率为３．７％。如何预防和减少...     

二尖瓣狭窄的球囊扩张术

二尖瓣狭窄的球囊扩张术山东省立医院（２５００２１）朱兴雷经皮二尖瓣球囊扩张术（ＰＢＭＶ）因其创伤小，深受欢迎。本技术１９８４年由日本Ｉｎｏｕｅ用于临床，１９８５年Ｌｏｃｋ应用聚乙烯球囊导管成功地扩张了狭窄的二尖瓣。我国于１９８５年引进日本Ｉｎｏｕｅ技...     

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。     

球囊扩张术治疗中晚期妊娠合并风湿性心脏病二尖瓣狭窄的研究

目的:探讨二尖瓣球囊扩张术是否为治疗中晚期妊娠合并风湿性心脏病患者的有效方法。方法:11例严重风湿性心脏病二尖瓣狭窄合并妊娠的患者,妊娠中晚期反复发生心力衰竭,5例进行经皮二尖瓣球囊扩张术,6例药物治疗。结果:5例经皮二尖瓣球囊扩张手术者术后二尖瓣口面积增大,心功能明显改善,妊娠和分娩过程及产后心功能稳定,婴儿发育均正常。6例因各种原因未行手术者终因心功能失代偿而被迫终止妊娠。1例患者死亡。结论:经皮二尖瓣球囊扩张术治疗妊娠合并风湿性心脏病二尖瓣狭窄、心功能失代偿的患者,是可行并且安全有效的急救方法。     

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。     

再次经皮球囊二尖瓣成形术治疗成形术后再狭窄的疗效观察

目的　评价再次经皮球囊二尖瓣成形术 (PBMV)治疗二尖瓣狭窄PBMV术后再狭窄的临床疗效。方法　采用Inoue法对 2 9例PBMV术后再狭窄患者进行再次PBMV ,并与 2 5 8例首次接受PBMV的患者进行疗效比较。结果　再次PBMV后二尖瓣口面积由 ( 0 98± 0 13)cm2 增至 ( 1 6 5±0 2 4)cm2 (P <0 0 0 1) ,二尖瓣跨瓣压差由 ( 2 6 5± 1 44 )kPa( 1kPa =7 5mmHg)降至 ( 0 79± 0 2 3)kPa(P<0 0 0 1) ,左房平均压由 ( 3 37± 0 6 2 )kPa降至 ( 1 6 6± 0 93)kPa(P <0 0 0 1) ,左房内径由 ( 4 5 2± 0 5 7)cm降至 ( 4 17± 0 5 0 )cm(P <0 0 5 )。再次PBMV组二尖瓣口面积增加值与左房平均压下降值小于首次PBMV组 [分别为 ( 0 6 7± 0 11)cm2 vs( 0 88± 0 32 )cm2 (P <0 0 5 )与 ( 1 71± 0 88)kPavs( 1 94± 0 5 6 )kPa(P <0 0 5 ) ]。再次PBMV组无心包填塞、死亡发生 ,主要并发症为重度二尖瓣反流 2例。结论只要选择合适病例 ,再次PBMV术仍可取得显著的即刻血流动力学改善 ,是PBMV术后再狭窄患者的一种安全而有效的治疗方法。     

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 .     

风湿性心脏病二尖瓣狭窄左房血栓形成的相关因素

目的：探讨风湿性心脏病二尖瓣狭窄(风心二狭)患考左房血栓形成的相关因素。方法：162例风心二狭并行心脏外科手术治疗患，术前常规做经胸心脏彩超检查，术中仔细寻找左房血栓。结果：房颤、二尖瓣返流是风心二狭思考左房血栓形成的相关因素，其相对危险度分别是17．744、0．468。年龄、左室舒张末期内径、左室射血分数、二尖瓣口面积在单因素分析中表现出一定的相关性，但在逐步logistic回归分析中并无统计学意义。在二尖瓣返流患中，随着返流的加重，左房血栓发生率下降。结论：风心二狭病人，房颤患易形成左房血栓。二尖瓣返流对血栓形成起保护作用，二尖瓣口面积与血栓形成的关系尚需进一步明确。     

经皮球囊二尖瓣成形术疗效和术后左心房重构的可控影响因素

目的 探讨经皮球囊二尖瓣成形术(PBMV)治疗二尖瓣狭窄的疗效和术后左心房重构的可控影响因素.方法 选取我院1998年3月至2002年6月行PBMV的二尖瓣狭窄患者96 例.收集术前、术后1周和术后4～6年超声心动图、12导联心电图等临床资料进行回顾性分析.采用多元逐步回归方法分析影响术后左心房重构的可控临床因素.结果 PBMV术前左心房内径与术后1周比较差异无统计学意义[(44.6±6.6)cm比(42.8±6.5)cm,P>0.05];术后4～6年左心房内径为(47.2±5.7)cm,均大于术前和术后1周(P均<0.05).与术前比较,术后1周和4～6年二尖瓣口面积均较大[(2.02±0.43)cm2和(1.98±0.36)cm2比(1.06±0.32)cm2,P均<0.05].术后1周和术后4～6年心功能Ⅰ和Ⅱ级(纽约心脏病学会分级)患者比例均高于术前(P<0.01).多元回归分析显示,与术后4～6年左心房内径相关的可控因素包括术后4～6年收缩压水平、术后1周二尖瓣口面积、术前心房颤动、术前Wilkins积分≤8分,术前左心房内径(P均<0.05).结论 PBMV治疗二尖瓣狭窄的近期效果明显.术后4～6年收缩压水平、术后1周二尖瓣口面积、术前心房颤动、术前Wilkins积分≤8分、术前左心房内径是影响术后左心房内径的重要因素.

Abstract：

Objective To observe the outcome and assess related factors affecting left atrial remodeling after percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral valve stenosis. Methods From March 1998 to June 2002,there were 96 mitral valve stenosis patients who underwent PBMV in our hospital. Echocardiographic,12 leads united electrocardiogram and other clinical datas were collected at preoperation,1 week after operation,and 4-6 years after operation to retrospectiveanalysis. Multiple stepwise regression analysis was used to assess controllable factors of left atrial remodeling. ResultsLeft atrial diameter reduced from (44.6±6.6)cm before PBMV to (42.8±6.5)cm (P>0.05) 1 week after PBMV and enlarged to (47.2±5.7)cm (all P<0.05) at the end of 4-6 years follow up post operation. The mitral valve area (MVA) increased from (1.06±0.32) cm2 before PBMV to (2.02±0.43) cm2 1 week after PBMV and (1.98±0.36)cm2 4-6 years post operation (all P<0.05). Heart function assessed by NYHA classification improved significantly at 1 week and 4-6 years after surgery compared with pre-operation(P<0.01). Multiple stepwise regression analysis showed that systolic blood pressure at 4-6 years after operation, MVA at 1 week after operation, preoperative atrial fibrillation, Wilkins score≤8, preoperative left atrial diameter were the independent predictive factors of left atrial remodeling at 4-6 years after PBMV.Conclusions PBMV was an effective therapy option for patients with mitral valve stenosis.Systolic blood pressure at 4-6 years after operation, MVA at 1 week after operation, preoperative atrial fibrillation, Wilkins≤8, preoperative left atrial diameter are the predictive factors of left atrial remodeling after PBMV.     

风湿性心脏病二尖瓣狭窄患者左房血栓形成的多因素回归分析

目的 :探讨风湿性心脏病二尖瓣狭窄 (风心二狭 )患者左房血栓形成的临床相关因素。方法 :6 9例风心二狭患者行经胸及食管超声心动图检查 ,并用发色底物显色法测定血浆组织型纤溶酶原激活物 (t PA )、组织型纤溶酶原激活物抑制物 1(PAI- 1)及抗凝血酶 (AT- )活性。结果 :33例风心二狭左房血栓形成组与 36例无血栓组比较 ,年龄偏大 ,症状持续时间较长 ,心房颤动发生率高 ;超声心动图显示左房内径较大 ,左室射血分数较低 ,二尖瓣口面积较小 ,明显二尖瓣关闭不全少见 ,左房自发性回声 (SEC)发生率明显增高 ;血液学检查显示红细胞压积较高 ,AT- 活性较低 t PA活性较高 ,PAI- 1活性较低。多元回归分析表明左房 SEC、AT- 活性、年龄、二尖瓣口面积大小是左房血栓形成的独立相关因素。结论 :风心二狭患者左房血栓的形成不仅与血流的局部机械性梗阻淤滞 ,而且与机体抗栓能力的下降有关。     

Treatment of severe mitral stenosis with percutaneous balloon valvotomy in pregnant patients

Background: Pregnancy can cause life-threatening complications in women with mitral stenosis. Frequently, there is an urgent need to increase the mitral valve area mechanically. In selected cases, percutaneous mitral balloon valvotomy (PMBV) has emerged as a safe and effective alternative to surgical commissurotomy. Hypothesis: The study evaluates the effects of PMBV by the Inoue technique in nine pregnant patients with severe symptomatic mitral stenosis. Methods: The patients were in New York Heart Association (NYHA) functional class II to IV and had echocardiographic scores of ≤ 8. The mean gestational age was 24.8 ± 6.1 weeks. The patient's pelvic and abdominal regions were covered with a lead apron to protect the fetus from radiation. A stepwise dilatation technique was used. Fluoroscopy time was kept to 10 to 15 min. Results: One patient developed severe mitral regurgitation requiring emergency valve replacement. The remaining eight patients showed marked immediate symptomatic and hemodynamic improvement. After dilatation, the transmittal pressure gradient decreased from 20.8 ± 6.5 to 7.3 ± 1.4 mmHg (p = 0.001) and the calculated mitral valve area increased from 0.9 ± 0.1 to 1.8 ± 0.4 (p < 0.001). All patients had uneventful term deliveries of normal babies. On follow-up they were in NYHA functional class I. Conclusions: Percutaneous mitral balloon valvotomy is a safe and effective procedure for selected pregnant patients with severe mitral stenosis. The procedure is well tolerated by the fetus. Severe mitral regurgitation requiring immediate surgery may occur occasionally. The possible harmful effects to the fetus from its exposure to radiation during PMBV are unknown.     

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     

Evaluation of early direct current cardioversion for maintenance of sinus rhythm in rheumatic atrial fibrillation following successful balloon mitral valvotomy

BackgroundPatients with rheumatic mitral stenosis (MS) and atrial fibrillation (AF) are at risk for thromboembolism and restoration of sinus rhythm (SR) may be the preferred strategy. Percutaneous balloon mitral valvotomy (PBMV) improves hemodynamics, but may not be enough to restore SR.MethodsProspective randomized study aimed at evaluating efficacy of early direct current cardioversion (DCCV) following successful PBMV in patients with long-standing AF. Group 1 (n = 20) had patients of rheumatic MS with AF who underwent successful PBMV. Group 2 (n = 15) patients were DC cardioverted and administered oral Amiodarone for 6 weeks. Primary endpoint was maintenance of SR after 6 months. Secondary endpoints were functional capacity, number of embolic episodes, adverse drug effects, and all-cause mortality.ResultsIn Group 2, all patients underwent successful cardioversion. At a mean follow-up of 7.6 months, 95% in Group 1 were in AF. In Group 2, 87% patients were in SR and 13% had reverted to AF. Difference in rate of SR was 0.82 (95% CI 0.2, 1.01) (p = 0.001), with relative risk of 7.1 (1.95, 25.9, 95% CI, p = 0.001) for patients to be in AF who underwent only successful PBMV, i.e. Group 1. There was significant improvement in quality of life (SF36) score in Group 2 (p = 0.001), with no deaths, stroke, or adverse drug effects in either group.ConclusionIn patients with rheumatic MS and AF, early DCCV and a short-duration oral Amiodarone, following successful PBMV, may be a reasonable strategy to attain long-term SR.     

A randomized placebo-controlled trial with amiodarone for persistent atrial fibrillation in rheumatic mitral stenosis after successful balloon mitral valvuloplasty

ObjectiveAtrial fibrillation is the most common sustained arrhythmia in patients with rheumatic heart disease (RHD). This study was conducted to determine the maintenance of sinus rhythm with amiodarone therapy following DC cardioversion (DCCV), early after successful balloon mitral valvuloplasty (BMV).MethodsPatients were randomized to amiodarone group and placebo group and their baseline characteristics were recorded. DCCV was done 48 h after BMV. After cardioversion, oral amiodarone was started initially 200 mg three times a day for 2 weeks, then 200 mg twice daily for two weeks followed by 200 mg once daily for 12 months. Patients in placebo group received DCCV alone without preloading amiodarone. After DCCV, they were given placebo for 12 months.ResultsThe 3 months follow-up period was completed by 77 patients (95%). Of them, 31 (77.5%) patients in amiodarone group and 14 (34.1%) in placebo group remained in sinus rhythm (SR). The 12 months follow-up period was completed by 73 patients (90.1%). Of them, 22 (55%) patients in amiodarone group and 7 (17.1%) in placebo group remained in SR.ConclusionWe conclude that amiodarone is more effective than placebo in maintenance of SR at the end of 3 months following successful cardioversion and more patients continued to remain in SR even at the end of 12 months without major serious adverse effects.     

Effect of balloon mitral valvotomy on left ventricular function in rheumatic mitral stenosis

AimMitral stenosis (MS) is found to produce left ventricular (LV) dysfunction in some studies. We sought to study the left ventricular function in patients with rheumatic MS undergoing balloon mitral valvotomy (BMV). Ours is the first study to analyze effect of BMV on mitral annular plane systolic excursion (MAPSE), and to quantify prevalence of longitudinal left ventricular dysfunction in rheumatic MS.MethodsIn this prospective cohort study, we included 43 patients with severe rheumatic mitral stenosis undergoing BMV. They were compared to twenty controls whose distribution of age and gender were similar to that of patients. The parameters compared were LV ejection fraction (EF) by modified Simpson's method, mitral annular systolic velocity (MASV), MAPSE, mitral annular early diastolic velocity (E′), and myocardial performance index (MPI). These parameters were reassessed immediately following BMV and after 3 months of procedure.ResultsMASV, MAPSE, E′, and EF were significantly lower and MPI was higher in mitral stenosis group compared to controls. Impaired longitudinal LV function was present in 77% of study group. MAPSE and EF did not show significant change after BMV while MPI, MASV, and E′ improved significantly. MASV and E′ showed improvement immediately after BMV, while MPI decreased only at 3 months follow-up.ConclusionsThere were significantly lower mitral annular motion parameters including MAPSE in patients with rheumatic mitral stenosis. Those with atrial fibrillation had higher MPI. Immediately after BMV, there was improvement in LV long axis function with a gradual improvement in global LV function. There was no significant change of MAPSE after BMV.