经皮二尖瓣球囊扩张术治疗重度二尖瓣狭窄疗效分析

目的 探讨经皮二尖瓣球囊扩张术(PBMV)治疗重度二尖瓣狭窄的疗效及安全性.方法 采用改良的房间隔定位法对56例重度二尖瓣狭窄患者行逐步球囊扩张.结果 PBMV有效扩大二尖瓣口面积,与术前比较,术后左心房压下降[(2.36±0.41)kPa比(3.92 ±0.75)kPa]、二尖瓣跨瓣压差显著下降[(2.13±0.74)kPa比(3.71±1.54)kPa],左心房内径减小[(43.7±6.1)mm比(50.2±5.6)mm]、二尖辩口面积扩大[(1.65±0.31)cm2比(0.61±0.12)cm2],差异均有统计学意义(P均＜0.01),心功能显著改善.结论 PBMV治疗重度二尖瓣狭窄是安全有效的.     

经皮二尖瓣球囊成形术(附22例报告)

本文报导22例经皮二尖瓣球囊成形术（PBMV），均获成功。左心房压从术前2．87±1．06降至术后1．20±0．49KPa（P＜0．001），二尖瓣辩跨瓣压差从2．8±0．71降至0．71±0．11KPa（P＜0．001）。二尖瓣瓣口面积自1．08±0．38增至2．11±0．40cm2（P＜0．001）。PBMV创伤小且安全，厅发局，故用于二尖瓣狭窄非手术治疗，深受患者欢迎。     

经皮二尖瓣球囊成形术治疗伴重度钙化二尖瓣狭窄33例观察及护理

目的 :观察风湿性心脏病 (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 (PBMV)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     

经皮二尖瓣球囊成形术治疗二尖瓣狭窄伴重度钙化的临床观察及护理

[目的]探讨风湿性心脏病(RHD)伴重度钙化的二尖瓣狭窄(MS)病人行经皮二尖瓣球囊成形术(PBMV)的近期疗效及安全性.[方法]回顾性分析63例伴重度钙化的MS病人行逐步球囊扩张法PBMV治疗的临床资料.[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安全、有效.     

经皮球囊二尖瓣扩张术对心房纤颤的影响

我们对43例二尖瓣狭窄合并房颤患者施行经皮二尖瓣球囊扩张术（PBMV），术后2～3个月进行电转复，以探讨房颤转复窦律的成功率及维持窦律的远期疗效。1资料和方法1．1病例选择：78例均符合以下条件：（1）中度以上二尖瓣狭窄，瓣口面积＜1．5cm[2]，不伴严重瓣叶或瓣环钙化；（2）心功能（NYHA）Ⅱ～Ⅲ级；（3）近期无风湿活动；（4）无或合并轻度二尖瓣关闭不全；（5）无或合并轻度主动脉瓣关闭不全或狭窄。其中43例二尖瓣狭窄合并心房纤颤，年龄36～58岁，平均48±7岁。男11例，女32例。心功能Ⅱ级26例，Ⅲ级17例。另设对照组28例，为…     

高龄二尖瓣狭窄患者经皮二尖瓣球囊扩张术治疗的疗效分析

目的：分析60岁以上二尖瓣狭窄的患者行经皮二尖瓣球囊扩张术（percutaneousballoonmitralvalvuloplasty,PBMV）治疗的安全性和临床效果。方法：29例60岁以上二尖瓣狭窄的患者,食道超声示未见左房血栓后,采用Ross法穿刺房间隔,用Inoue球囊进行扩张,所有患者术前、术后应用体表超声心动图监测其二尖瓣瓣口面积、跨瓣压差、左心房直径、左心房平均压。肺动脉压力以及二尖瓣反流与否。手术后24h、1个月、6个月应用体表超声心动图随访。结果：29例患者均成功实施球囊扩张术,术后及随访6个月时左心房平均压、左心房直径、肺动脉压力较术前均降低,差异有统计学意义（P〈0．05）。1例术前二尖瓣轻微反流,术后为轻度到中度反流。29例患者术后心功能均得到明显改善,舒张期杂音完全消失或减弱。结论：对于瓣膜无明显钙化、瓣下结构超声心动评分≤6分、心功能Ⅲ级以上、合并其他瓣膜病变较轻的老年患者,PBMV同样可以取得较好的疗效。     

经皮二尖瓣球囊成形术治疗二尖瓣狭窄伴轻中度二尖瓣关闭不全的疗效评价

目的:探讨风湿性心脏病(RHD)二尖瓣狭窄(MS)伴轻中度二尖瓣关闭不全患者经皮二尖瓣球囊成形术(PBMV)的效果。方法:将33例二尖瓣狭窄伴轻度关闭不全(A组)和30例二尖瓣狭窄伴中度关闭不全(B组)及36例单纯二尖瓣狭窄(C组)的PBMV术后即刻及随访结果作对比研究。结果:A组左房平均压(MLAP)从术前(25.2±5.6)mmHg降至术后(10.2±3.2)mm-Hg,B组左房平均压(MLAP)从术前(26.3±5.2)mmHg降至术后(10.9±4.2)mmHg,C组左房平均压(MLAP)从术前(23.8±7.1)mmHg降至术后(9.5±4.2)mmHg,三组间比较P>0.01,差别无显著性。A组二尖瓣返流术前(14±3.5)％,术后(15±2.6)％,P>0.01,差别无显著性;B组二尖瓣返流术前(30±6.8)％,术后(35±4.5)％,P>0.01,差别无显著性;C组术前0％,术后(2±0.2)％,P>0.01,差别无显著性。A组、B组、C组随访左房内径逐渐缩小。结论:MS合并轻中度二尖瓣返流,PBMV是一种有效和安全的治疗措施,可列入PBMV的手术适应症。     

超声心动图对急症诊断经皮二尖瓣球囊扩张术瓣叶穿孔的价值

本文分析5例风湿性心脏病重度二尖瓣狭窄患者，经皮二尖瓣球囊扩张术（PBMV）后，瓣叶穿孔的超声心动图（UCG）特异性表现为：原狭窄的二尖瓣口无改变，而瓣叶（多见前叶）回声连续中断，彩色多普勒显示（CDFI）收缩期大量蓝色为主返流束经撕裂穿孔瓣叶入左房，此表现为急症诊断PBMV穿孔提供了明确可靠的依据。     

经皮球囊二尖瓣成形术203例临床分析

自从1984年Inoue报道穿剌房间隔用特制球囊扩张狭窄的二尖瓣以来,经皮球囊二尖瓣成形术（PBMV）迅速得以推广应用,使得很多风心患免除了开胸手术的痛苦.本旨在进一步探讨PBMV术前、术后瓣口面积的改变及血流动力学变化、心功能变化的近期疗效和安全性评价.     

经皮二尖瓣球囊扩张术治疗风湿性二尖瓣狭窄的随访观察

目的:观察经皮二尖瓣球囊扩张术(PBMV)治疗风湿性二尖瓣狭窄的中远期疗效。方法:采用Inoue单球囊对150例风湿性二尖瓣狭窄患者行PBMV治疗,并进行了长期随访,随访时间12～96(46±22)月。结果:二尖瓣瓣口面积由0.98±0.16cm~2增至1.86±0.54cm~2,二尖瓣平均跨瓣压差由19.6±7.2mmHg降至10.3±5.6mmHg,10例出现明显再狭窄,其中6例再次行PB-MV术,4例行瓣膜置换术。结论:PBMV治疗风湿性二尖瓣狭窄的中远期效果良好,瓣下病变的严重程度将影响中远期疗效。     

Imaging in mitral stenosis: assessment before,during and after percutaneous balloon mitral valvuloplasty

Detailed assessment of mitral valve morphology is required to select patients for successful percutaneous balloon mitral valvuloplasty (PBMV). The mitral valve is routinely imaged using transthoracic and transesophageal echocardiography, which have more recently been supplemented with magnetic resonance imaging, 3D echocardiography and intracardiac echocardiography. The scope of PBMV is expanding and it is increasingly used for patients previously considered to have unfavorable mitral morphology. Here we review the evidence to support the examination of each component of the mitral valve and its surrounding structures and the advantages of each imaging modality. Appropriate echocardiographic views are recommended and periprocedural and postprocedural imaging techniques are discussed.     

Atrial fibrillation and mitral valve repair

Atrial fibrillation (AF) is present in 30–40% of patients presenting for mitral valve surgery. In patients undergoing mitral valve repair, the presence of AF may be associated with increased mortality and morbidity and this is also the case in patients in whom AF persists postoperatively. Advances in understanding the pathogenesis of AF led to techniques that include both mitral valve repair and ablation of AF. The concomitant surgical treatment of AF during mitral surgery has become a commonly performed procedure, which was shown to be safe and which may improve the outcome for patients. AF after mitral valve replacement is an accepted indication for anticoagulation, but the data supporting anticoagulation in patients after mitral valve repair who convert to sinus rhythm are sparse. This article reviews the available data regarding outcomes of mitral repair and how they are influenced by AF and its therapy.     

二尖瓣成形术治疗二尖瓣后瓣脱垂伴重度关闭不全后收缩期前向运动征1例

<正>患者男,48岁,活动后胸痛伴头晕、恶心及心悸等3个月;10余年前因“胆囊结石”接受“单孔腹腔镜胆囊切除术”。查体：脐上缘见长2.5cm横行手术瘢痕,二尖瓣区闻及2/6级收缩期杂音。实验室检查未见明显异常。经胸超声心动图（transthoracic echocardiography,TTE）：左心房前后径44mm,左心室舒张末期内径54mm,室间隔厚度9mm;左心室射血分数66%;二尖瓣后瓣P1收缩期脱向左心房侧,超过瓣环水平,二尖瓣偏向房间隔大量反流;提示二尖瓣后瓣脱垂伴重度关闭不全。     

Concomitant decalcification of the anterior mitral leaflet via the aortic annulus during aortic valve replacement for significant aortic and mitral stenoses

An 82‐year‐old man undergoing regular hemodialysis with substantial aortic and mitral valve stenoses underwent aortic valve replacement with concomitant mitral decalcification via the aortic annulus. Postoperative transthoracic echocardiography showed reduced mitral stenosis. The patient was discharged on the 14th postoperative day uneventfully.     

Ongoing and future directions in percutaneous treatment of mitral regurgitation

Introduction: Mitral regurgitation (MR) is one of the major valvular disease. Although surgical mitral valve (MV) repair is the standard of care for patients with severe MR, an unmet need exists in the management of patients with severe symptomatic MR and high surgical risk. Transcatheter MV therapies are alternative treatment option in such patients with moderate to severe and symptomatic MR.

Areas covered: Literatures to direct the reader to important further reading were searched with relevant websites; www.ncbi.nlm.nih.gov/pubmed using search word ‘transcatheter mitral intervention’.

Expert commentary: A variety of transcatheter techniques have emerged for the percutaneous treatment of MR. We should carefully select one or combination procedure for each patient as an ideal tailor-made transcatheter MV therapy in order to improve the outcomes.     

Predictors of adverse outcomes after transcatheter mitral valve replacement

Introduction: Transcatheter mitral valve replacement (TMVR) is still a recent technology with numerous unknowns but also great promises. The risk of complications reported in observational studies have limited its adoption by interventional cardiology and surgical communities.

Areas covered: Some of the major setbacks of TMVR are complications related to the devices and those related to the pathway. Device-related complications include left ventricle outflow tract (LVOT) obstruction, transcatheter heart valve (THV) dislocation or embolization, thrombosis, and stroke. The transapical approach currently remains the main pathway for TMVR but is associated with high risk of major bleeding and residual apical myocardial scarring. Complication prediction and prevention seem possible. Device-related complication prediction is based on pre-operative imaging including multi-slice computed tomography with 3-dimensional reconstructions and echocardiography which allow LVOT obstruction prediction and appropriate sizing aiming at avoiding dislocation. Industry should aim at the development of transfemoral delivery systems. Nevertheless, several recent feasibility observational studies suggested acceptable safety and efficacy of transcatheter mitral valve replacement.

Expert opinion: TMVR complications and transapical delivery are some of the main setbacks which need to be addressed for TMVR to be adopted for broad clinical use.     

瓣环扩大在功能性二尖瓣返流机制中的作用

目的探讨瓣环扩大在功能性二尖瓣返流机制中的作用。方法应用超声心动图检查房颤组(20例)、返流组(30例)及正常组(20例)的心脏,测量二尖瓣返流比例、左室射血分数(EF)、左室大小、球形度、收缩期瓣环(MA)面积、收缩期后乳头肌与二尖瓣前瓣环的距离(PPMAMA)。结果房颤组左室大小、球形度、EF、PPMAMA和正常组相比没有统计学差异,但收缩期MA面积较正常组明显扩大,并与返流组相似,分别为(5.3±1.1)cm2、(7.4±1.5)cm2、(8.0±2.0)cm2,但房颤组二尖瓣返流量明显小于功能性二尖瓣返流组,分别为(12±7)%和(30±14)%。结论单纯瓣环的扩张似乎并不引起中或重度二尖瓣返流。     

Echocardiographic quantitation of mitral regurgitation

Mitral valve regurgitation is a common valvular problem, particularly in developing nations. It causes significant morbidity and mortality, especially if the severity of valve regurgitation is underestimated. Echocardiography plays a significant role in the diagnoses, serial follow-up and management of patients with valvular heart disease. However, precise quantitation of the severity of mitral regurgitation is a crucial element in the therapeutic decisions for managing mitral regurgitation. An accurate assessment of the severity of mitral regurgitation allows for optimal timing of surgical intervention, culminating in improved patient outcomes. This review provides a systematic approach to the quantitation of mitral regurgitation using the echocardiography and Doppler methodologies that are available in the modern noninvasive imaging and hemodynamic laboratory. Additional, novel and evolving noninvasive imaging modalities are reviewed briefly.     

超声心动图在降落伞状二尖瓣畸形诊断中的应用价值

目的探讨超声心动图诊断降落伞状二尖瓣(PMV)的价值,并与术中结果进行对比分析.方法2002年1月-2005年6月应用常规经胸超声心动图(TTE)、经食管超声心动图(TEE)及经胸实时三维超声心动图(RT-3DE)诊断PMV共11例,进行回顾性分析,男7例,女4例,年龄1～64岁,平均21岁.结果超声诊断单纯PMV 3例(27.3%),合并其他心内畸形8例(72.7%).11例患者均有不同程度的二尖瓣狭窄,5例伴有二尖瓣反流.9例行手术治疗,术中所见和超声诊断一致,符合率100%.4例患者行二尖瓣置换术,1例行二尖瓣成形术,3例仅行室间隔修补术.结论常规TTE、TEE、RT-3DE均能诊断PMV,RT-3DE与传统的二维成像技术相比包含了更多的诊断信息,具有潜在的临床应用价值.