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。     

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。     

经皮球囊二尖瓣成形术治疗二尖瓣狭窄合并房颤的疗效

目的　对二尖瓣狭窄 (MS)合并房颤 (Af)患者经皮球囊二尖瓣成形成术 (PBMV)后 3～ 11年的随防资料作回顾性分析 ,以探讨该方法在MS合并房颤 (Af)患者中的中远期疗效及其影响因素。方法　对 1992年 10月～ 2 0 0 0年 12月在我院行PBMV治疗的 60 0例MS患者的资料作回顾性研究 ,合并Af者 2 75例 (Ⅰ组 ) ,其余 3 2 5例为窦性心律者 (Ⅱ组 ) ,随防时间 3年～ 11年 ,平均 ( 5 .3± 3 .9)年。结果　Ⅰ组与Ⅱ组比较 ,中远期再狭窄率分别为 3 2 .3 %和 10 % ,需要药物治疗的心功能不全分别为 2 7%和 3 .6% ,死亡率分别为 1.8%和 0 .9% ,改行开胸换瓣或再次PBMV分别为 8.8%和 1.3 5 % ,脑栓塞分别为 2 .6%和 0 .45 %。结论　PBMV对MS合并Af患者的治疗中远期疗较窦性心律者差 ;总的并发症不高 ,疗效较好 ,预防并发症的发生及取得远期良好疗效的关键是病例选择     

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.     

经皮球囊二尖瓣成形术治疗二尖瓣狭窄合并房颤的近期与远期疗效

目的　探讨经皮球囊二尖瓣成形术 (PBMV)在二尖瓣狭窄 (MS)合并心房颤动 (Af)患者中的疗效与安全性。方法　观察 12 5例MS合并Af患者 (Ⅰ组 )与 2 2 5例MS伴窦性心律患者 (Ⅱ组 )的PBMV成功率、PBMV后血流动力学与超声心动图指标改变、远期随访结果及并发症情况。结果　(1)两组成功率分别为 96 %(12 0 12 5 )和 99 6 %(2 2 4 2 2 5 ) (P <0 0 5 )。 (2 )PBMV后即刻两组左心房压力与肺动脉压力均明显下降 (P均 <0 0 0 1) ,Ⅰ组前者降值 <Ⅱ组 (P <0 0 5 )。 (3)PBMV后近期两组二尖瓣口面积 (MVA)明显增大 (P均 <0 0 0 1) ,组间无差异 ;两组左心房内径 (LAD)明显下降 (P均 <0 0 0 1) ,Ⅰ组下降值 <Ⅱ组。 (4)远期随访两组再狭窄率分别为 17 0 %(8 4 7)和 6 9%(4 5 8) (P <0 0 5 ) ;两组死亡率分别为 4 1%(2 4 9)和 1 7%(1 5 9) (P <0 0 5 ) ;两组MVA与LAD均仍较术前明显改善 ,但Ⅰ组较Ⅱ组差 ,且Ⅰ组MVA较术后近期结果缩小 (P <0 0 5 )。 (5 )两组并发症发生率分别为16 8%及 10 7%,组间差异无显著性 ,但 5例体循环栓塞者均发生于Ⅰ组。结论　PBMV在MS合并Af者中成功率高 ,再狭窄率低 ,疗效确切 ,但较窦性心律组差 ,需注意防止体循环栓塞 ,故对合并Af者更应严格病例选     

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 .     

二尖瓣狭窄并发房颤行球囊成形术前抗凝与不抗凝的比较

目的 :评价二尖瓣狭窄并发房颤患者行经皮二尖瓣球囊成形术 （PBMV）前是否需要常规抗凝治疗。方法 :风湿性心脏病二尖瓣狭窄并发房颤患者 2 5 1例 ,按就诊先后随机分为 A（n=12 6 ） ,B（n=12 5 ）两组。控制心力衰竭后行PBMV。A组术前不使用任何抗凝药物及抗血小板药物 ,B组术前常规给予肝素、肠溶阿斯匹林及华法令抗凝 ,观察PBMV术中及术后 3d有无与 PBMV相关的体循环栓塞并发症。结果 :两组患者 PBMV均获成功 ,术中及术后均无栓塞并发症发生 ,术后血流动力学指标、心功能、二尖瓣口面积、心脏杂音均有明显改善 （P<0 .0 1）。结论 :二尖瓣狭窄并发房颤患者如既往无体循环栓塞史 ,左心房无附壁血栓 ,行 PBMV前并不需苛求常规抗凝。     

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.     

经皮球囊二尖瓣成形术后房颤患者ANP和BNP水平变化研究

目的探讨房颤患者行经皮球囊二尖瓣成形术（PBMV）后心房利钠肽（ANP）和脑钠肽（BNP）变化及与血流动力学参数的关系。方法选择因风湿性二尖瓣狭窄伴持续性房颤成功行PBMV患者38例,术前、术后1d及半年分别用放射免疫法和酶链免疫法测定血浆中ANP、BNP值,由超声心动图测左房内径（LAD）、二尖瓣口面积（MVA）、二尖瓣跨瓣压差（MPG）及肺动脉压（PAP）。结果PBMV术后患者血流动力学参数明显改善;术后1d及半年ANP水平较术前明显下降,BNP变化不明显。术后半年与术前比较,LAD与ANP下降相关（r=0．774,P〈0．05）,△BNP与△MPG相关（r=0．574,P〈0．05）。结论房颤患者PBMV术后半年血中ANP逐步下降,BNP降低不明显。房颤律时△ANP和△BNP仍是反映LAD和MPG变化的有效指标。     

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。     

Combined percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation for rheumatic mitral stenosis and atrial fibrillation

Rheumatic heart disease is a common cause of cardiovascular morbidity and mortality worldwide, mostly in developing countries. Mitral stenosis and atrial fibrillation often coexist, related to both structural and inflammatory changes of the mitral valve and left atrium. Both predispose to left atrial thrombus formation, commonly involving the left atrial appendage. Thromboembolism can occur, with devastating consequences. We report the case of a 62 year old woman with rheumatic heart disease resulting in mitral stenosis and atrial fibrillation. Previous treatment with warfarin resulted in life-threatening gastrointestinal bleeding and she refused further anticoagulant therapy. A combined procedure was performed, including percutaneous balloon mitral valvuloplasty and left atrial appendage occlusion device implantation with the Atritech® Watchman® device. No thromboembolic or bleeding complications were encountered at one year follow-up. Long-term follow-up in a cohort of patients will be required to evaluate the safety and efficacy of this strategy.     

Effects of percutaneous balloon mitral valvuloplasty on plasma B-type natriuretic peptide in rheumatic mitral stenosis with and without atrial fibrillation

BACKGROUND AND AIM OF THE STUDY: The study aim was to evaluate the effect of percutaneous balloon mitral valvuloplasty (PBMV) on plasma B-type natriuretic peptide (BNP) levels in patients in sinus rhythm (SR) and with atrial fibrillation (AF). METHODS: Thirty patients with rheumatic mitral stenosis who underwent successful PBMV were included in the study. Of these patents, 21 were in SR (SR group) and nine had AF (AF group). Plasma BNP levels were measured using the Triage BNP Test in all patients before, and at 20 min and 24 h after, PBMV. Control levels were measured in eight healthy volunteers. RESULTS: Basal plasma BNP levels in patients were significantly higher than those in controls (123.5 +/- 69.5 versus 16.4 +/- 7.6 pg/ml, p < 0.01), and correlated with mean left atrial pressure (mLAP; r = 0.441, p < 0.05) and pulmonary artery pressure (PAP; r = 0.488, p < 0.01). No significant difference was observed in BNP levels between the SR and AF groups. In the SR group, BNP levels decreased after PBMV (pre-PBMV 128.7 +/- 75.9 pg/ml; at 20 min, 88.6 +/- 62.0 pg/ml; at 24 h, 43.4 +/- 26.7 pg/ml; respectively, p < 0.05). Changes in plasma BNP (deltaBNP) correlated positively with those in mLAP (deltamLAP) (r = 0.696, p < 0.01) and PAP (deltaPAP) (r = 0.456, p < 0.05). Left ventricular end-diastolic volume (LVEDV) (96.1 +/- 21.6 versus 111.5 +/- 25.2 ml, p < 0.01) and stroke volume (SV) (59.2 +/- 15.8 versus 69.0 +/- 17.9 ml, p < 0.05) augmented accordingly without any changes in left ventricular end-diastolic pressure (LVEDP) (p = NS). In contrast, in group AF, BNP levels remained unchanged (pre-PBMV 111.6 +/- 53.4 pg/ml; at 20 min, 122.0 +/- 68.7 pg/ml; at 24 h, 106.1 +/- 56.2 pg/ml; respectively, p = NS), while LVEDP increased (6.4 +/- 3.6 versus 8.6 +/- 3.2 mmHg, p < 0.01), without any changes in LVEDV and SV (p = NS). CONCLUSION: The study results indicate that, in mitral stenosis patients, a high BNP level is associated with high mLAP and PAP. Cardiac rhythm may play an important role in changes of BNP level after PBMV. BNP may be a valid marker to reflect changes in mLAP and PAP after PBMV in patients with SR, but not in those with AF.     

老年人经皮球囊二尖瓣成形术

目的:探讨经皮球囊二尖瓣成形术(PBMV)治疗老年人二尖瓣狭窄(MS)的临床疗效。方法:采用Inoue法对13例年龄≥60岁的MS患者施行PBMV,其中10人接受5-12年中长期随访,收集术前、术后及随访结束时有关心脏参数,进行分析比较。结果:术前、术后及随访5-12年测得参数:(1)二尖瓣瓣口面积(MVA)分别为:0.96±0.15 cm2、1.73±0.27 cm2、1.51±0.32 cm2(P<0.01),后两者与术前比较P<0.01;(2)二尖瓣跨瓣压分别为2.82±1.51 kPa、0.87±0.34 kPa、1.52±0.41 kPa,后两者与术前比较P<0.01;(3)左房平均压分别为3.82±1.73kPa、1.81±0.95 kPa、2.16±0.52 kPa,后两者与术前比较P<0.01。术后心功能改善1级以上者100％,术后5-12年随访心功能仍维持在Ⅱ级以上者占80％,5-12年后再狭窄发生率20％。结论:PBMV治疗老年人MS的近期及中远期疗效均满意,未见严重并发症,是一种安全有效的治疗方法。     

分级次二尖瓣球囊扩张术治疗重度二尖瓣狭窄伴心房颤动的临床研究

为评价分级扩张法行经皮穿刺二尖球囊扩张术（PBMV）的临床疗效。采用分级次扩张法对52例风湿性二尖瓣狭窄（MS）患者进行,分重度MS伴心房颤动（AF）组和中，重度MS无AF组。根据身高2确定首次扩张直径，每次递量0.5-1mm，直至疗效满意。术前，术后进行二维超声和多普勒，血流动力学检查。结果显示，52例PBMV均获成功，术后血流动力学明显改善，心功能明显提高，无重要并发症发生，两组间比较无明显差异。提示分级次扩张法可有效预防二尖瓣反流，低心排，急性左心衰，栓塞等并发症，并获得良好效果，尤其对重度MS伴AE者，不失为一种理想的治疗方法。     

再次经皮球囊二尖瓣成形术39例远期疗效观察

目的 观察经皮球囊二尖瓣成形术后再狭窄的患者,行再次经皮球囊二尖瓣成形术的远期疗效.方法 39例经皮球囊二尖瓣成形术后再狭窄的患者,全部采用改良Inoue法,再次行经皮球囊二尖瓣成形术,并进行远期疗效随访.结果 39例患者再次行经皮球囊二尖瓣成形术,成功36例(成功率为92.3%).再次经皮球囊二尖瓣成形术成功后,患者临床症状及部分血流动力学指标(左心房平均压、二尖瓣瓣口面积、跨瓣压差及肺动脉收缩压)明显改善[分别为(24.50±6.54)mm Hg比(9.66±4.21)mill Hg(1 mm Hg=0.133 kPa),(1.05±0.19)cm2比(2.23±0.22)cm2,(17.03±4.52)mm Hg比(7.79±4.07)mm Hg,(58.12±12.68)mm Hg比(31.45±10.02)mm Hg,P均＜0.05];而左心房内径无明显改变[(4.71±0.75)cm比(4.07±0.69)cm,P＞0.05]. 36例患者再次经皮球囊二尖瓣成形术后随访12～146(69±23)个月,远期随访可见二尖瓣瓣121面积仍明显大于术前[(2.02±0.21)cm2比(1.05±0.19)cm2,P＜0.05],跨瓣压差明显小于术前[(9.15±4.11)mm Hg比(17.03±4.52)mm Hg,P＜0.05],且均与近期随访结果相近似[分别为(2.02±0.21)cm2比(2.23±0.22)cm2,(9.15±4.11)mm Hg比(7.79±4.07)mm Hg,P均＞0.05];而左心房内径仍无明显改变[(4.13±0.71)cm比(4.07±0.69)cm,P＞0.05].远期随访期间,大多数患者心功能及生活质量均明显改善.结论 对于经皮球囊二尖瓣成形术后再狭窄的患者,只要病例选择恰当,手术操作正确,再次行经皮球囊二尖瓣成形术的近期及远期疗效均佳.     

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.     

Favorable effect of balloon mitral valvuloplasty on the incidence of atrial fibrillation in patients with severe mitral stenosis.

BACKGROUND: The long-term effect of balloon mitral valvuloplasty (BMV) on the incidence of atrial fibrillation (AF) in patients with severe mitral stenosis (MS) remains undetermined. AIMS: To assess the effect of successful BMV on the incidence of chronic AF in patients with severe MS, compare the results with historical controls, and identify factors associated with AF in such patients. METHODS: Retrospective analysis of 382 consecutive patients with severe MS and in sinus rhythm (SR) who underwent successful BMV (post procedure mitral valve area (MVA) > or =1.5 cm(2), mitral regurgitation (MR) < or =2/4) at our hospital and followed-up for 1-15.6 (mean 5.6 +/- 3.9) years with clinical and echocardiographic examination. RESULTS: Thirty-four (8.9%) patients developed AF at follow-up (group A) and 348 patients (group B) remained in SR. At baseline, and in comparison with group B, patients who developed AF (group A) were older, had higher mitral echo score but equal MVA and left atrial (LA) size. The postprocedure MVA was smaller in group A (1.7 +/- 0.3 cm(2)) than in group B (2.0 +/- 0.2 cm(2;) P = 0.002). At follow-up, and in comparison to group B, group A had smaller MVA (1.5 +/- 0.4 cm(2) vs 1.8 +/- 0.4 cm(2) P <0.0001), larger LA dimension (49.4 +/- 6.5 vs 42 +/- 6.5 mm; P <0.0001) and higher restenosis rate (35% vs 14%; P = 0.001). Multivariate logistic regression analysis identified age at follow-up (P < 0.0001), LA size at follow-up (P = 0.004), and MVA at follow-up (P = 0.006) as predictors of AF. CONCLUSIONS: This study demonstrated favorable effect of BMV on the incidence of AF (8.9%) in patients with severe MS in comparison with reported series (29%) of patients with severe MS with similar baseline characteristics who were not submitted to any intervention. The predictors of AF were age, larger LA, and smaller MVA, at follow-up.     

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