经皮球囊二尖瓣成形术分析

目的 探讨进一步提高二尖瓣球囊成形术(PBMV)治疗二尖瓣狭窄(MS)的成功率、疗效及防止并发症发生.方法应用Inoue单球囊对56例MS行PBMV,观察术前、术后左房平均压、心功能、跨二尖瓣压力阶差(MVPG)及二尖瓣口面积(MVA).结果 本组心功能明显改善,左房平均压24.3±6.4降至11.6±3.5mmHg、MVPG从21.3±7.2降至3.9±2.6mmHg、MVA从1.01±0.31扩大到2.24±0.26cm~2.结论PBMV治疗MS是一种非手术有效安全的方法.     

应用国产球囊导管经皮穿刺二尖瓣成形术(附五例报告)

本文报告应用国产球囊导管对5例风湿性二尖瓣狭窄病例实行经皮穿刺单球囊二尖瓣成形术的治疗效果,手术后二尖瓣口面积分别由1.33,1.05,0.95,0.90及1.07cm~3扩张至2.47,1.52,2.15,1.60及1.92cm~2;跨二尖瓣压力阶差也分别由1.73,0.93,2.79,3.06及2.93kPa(13.0,7.0,21.0,23.0及22.0mmHg)降至0,0.13,0.27,0.13及1.06kPa(0,1.0,2.0,1.0及8.0mmHg);舒张期杂音由Ⅲ～Ⅳ级减至0～Ⅱ级,自觉症状及心功能均明显改善。作者认为,应用国产球囊导管,适当地简化手术程序,经皮穿刺球囊二尖瓣成形术可以安全地在有条件的基层医院开展。     

开展经皮二尖瓣球囊成形术的经验和体会

采用Ｉｎｏｕｅ法对５０例风心二尖瓣狭窄（ＭＳ）患者施行经皮二尖瓣球囊成形术（ＰＢＭＶ）治疗。单纯ＭＳ者１４例，伴二尖瓣返流（ＭＲ，１－２／４度）及轻度主动脉瓣病变３６例。房颤２１例，外科闭式分离术后再狭窄４例，术后血液动力学显著改善：左房平均压从２３．７±７．７降至１１．０±４．９ｍｍＨｇ（Ｐ＜０．００１），跨二尖瓣压差（ＭＶＰＧ）由２０．２±８．３降至４．１±３．２ｍｍＨｇ（Ｐ＜０．００１）。二尖瓣瓣口面积从０．９１±０．２０扩大到２．０３±０．２ｃｍ２（Ｐ＜０．００１），左房径从４．９６±０．８２缩小至４．１±０．５１ｃｍ（Ｐ＜０．０１），主功能从３±０．４６提高到１．３７±０．５１（Ｐ＜０．００１）。本组病例无１例发生严重并发症。掌握好房间隔穿刺技术，选择无明显瓣膜钙化和瓣下严重融合的病例，对房颤病人进行抗凝准备和正确掌握扩张终点是ＰＢＭＶ成功和减少严重并发症的重要保证。     

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。     

应用国产球囊导管经皮穿刺进行二尖瓣球囊成形术(附57例分析)

应用国产球囊导管,对57例风湿性心脏病二尖瓣狭窄患者进行经皮穿刺二尖瓣球囊成形术(PTMC)男性22例,女性35例,年龄22～51岁,病程4～25年,伴发房颤13例.瓣口面积0.67～1.4cm~2.在原有PTMC方法基础上进行了改进,采用球囊导管60～90度方向进入股静脉;创新采用三法定位校正法,进行房间隔穿刺;创新采用球囊导管反“C”字法进入狭窄的二尖瓣口.成功率96.5%,使手术时间出平均1.5～2.0/小时,缩短到40～50分钟,使x线曝光时间降至30分钟.本组国产球囊与Inoue球整操作过程中无明显差别.     

经皮二尖瓣球囊成形术治疗老年风湿性二尖瓣狭窄130例

经皮二尖瓣球囊扩张术(PBMV),具有创伤小、疗效佳、相对安全且术后恢复快的优点,成为二尖瓣狭窄(MS)的首选治疗方法。本文对130例60岁以上老年MS患者的PBMV术进行总结。1对象与方法1.1研究对象2006年1月至2011年7月在我院的住院60岁以上的风湿性MS患者130例,男56例,女74例,年龄60～     

重度二尖瓣狭窄的球囊成形术

本文对22例重度二尖瓣狭窄患者进行PBMV治疗.采用改良Inoue法8例,成功6例,应用我们设计的球囊负压操作法14例,全部成功,总成功率91%(20/22).血流动力学显著改善;左心房平均压由术前的3.11±0.82下降至0.91±0.81kPa(P <0.01),肺动脉平均任由4.32±1.52下降至2.78士1.48kPa(P<0.05),二尖瓣跨瓣压差由术前2.35士0.66下降至0.27土0.65kPa(P<0.01),二尖瓣口面积由术前0.69士0.11增加到1.73士0.47cm~2(P<0.01),心功能均明显改善.本组结果显示;采用球囊负压操作法可缩短手术操作时间,减少术中并发症,提高手术成功率.PBMV不仅适用于轻～中度二尖瓣狭窄的患者,亦适用于部分重度MS的患者,且后者较前者疗效更满意.     

妊娠中期经皮球囊二尖瓣成形术一例

<正> 经皮球囊二尖瓣成形术(PBMV)经十余年实践,已被证实为非手术治疗二尖瓣狭窄的安全可靠的方法.妊娠妇女施行PBMV,国内仅有个别报道.我院为一例妊娠28周妇女行PBMV,获得满意效果,现报告如下.患者25岁,活动后心慌气短五年,入院前两小时咯血200ml.查体:二尖瓣面容,两肺未闻罗音,心界叩诊稍向右扩大,心率100次/分,律齐,S_1及P_2亢进,心尖部闻舒张期隆隆样杂音Ⅱ～Ⅲ级,三尖瓣     

经皮球囊二尖瓣成形术治疗重症二尖瓣狭窄 (附19例报告)

本文总结1991年以来采用PBMV治疗重症二尖瓣狭窄19例,全组心功能改善Ⅰ级8例,Ⅱ级11例;舒张期杂音减轻到1°/6°15例,2°/6°4例;左房平均压降至2.17±0.26kPa.认为:只要重视每个环节的处理,该项技术治疗重症二尖瓣狭窄仍不失为一种安全有效的好方法.     

经皮穿刺二尖瓣狭窄球囊成形术35例分析

经皮穿刺二尖瓣狭窄球囊成形术３５例分析聊城地区人民医院（２５２０００）孔祥泉，薛玉增，李义波，金跃，曲才绪１９９４年３月～１９９５年１２月，我院施行经皮穿刺二尖瓣狭窄球囊成形术（ＰＢＭＶ）３５例，疗效满意。现报告如下。１材料与方法３５例均为风心病患者...     

Intracardiac echocardiography-guided percutaneous mitral balloon valvuloplasty

Percutaneous mitral balloon valvuloplasty (PMBV) was initially described by Inoue in 1984 as a novel percutaneous technique for the management of mitral stenosis. Intracardiac echocardiography was initially used in the 1980s but was not universally accepted due to its high-frequency transducers and problems with steerability and manipulation. In the 1990s technical improvements led to more generalized use in various structural interventional procedures. We present the case of a successful PMBV guided exclusively by ICE.     

Combined percutaneous mitral and aortic balloon valvuloplasty

Between August 1987 and November 1988, combined mitral and aortic balloon valvuloplasty was performed in 10 patients (mean age 42 +/- 9 years), all of whom had symptomatic mitral and aortic stenosis. The procedure was performed using a transarterial approach with a multiballoon catheter and an exteriorized intracardiac long guidewire circuit. The procedure could be considered successful in 9 patients where significant increases in the mean mitral (0.97 +/- 0.19 to 1.80 +/- 0.26 cm2) and aortic (0.63 +/- 0.18 to 1.15 +/- 0.32 cm2) areas were achieved. Severe mitral regurgitation that required surgery developed in 1 patient in the following 24 hours. Femoral vascular surgery was necessary in 1 patient. Mid-term follow-up was available in 8 patients for a period averaging 8 +/- 3 months. The 9 patients in whom the procedure was successful showed persistent clinical improvement in functional class, Doppler echocardiography showed 2 cases of aortic restenosis and none of mitral restenosis. Combined mitral and aortic balloon valvuloplasty could be a valid alternative treatment in selected patients with both mitral and aortic rheumatic stenosis. Further experience and long-term hemodynamic follow-up are necessary to define the role of this mode of treatment.     

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。     

Simplified percutaneous mitral valvuloplasty with the Inoue balloon

Background Percutaneous mitral valvuloplasty with the Inoue balloon isconventionally performed with double vascular access: arterialand venous. However, in patients with a good echogenic windowit may be performed with venous access only and the proceduremonitored by 2D-echocardiography and colour flow mapping. Thisshould result in early ambulation and hospital discharge withreduced arterial complications. Aims To compare retrospectively the immediate results of percutaneousmitral valvuloplasty with the Inoue balloon in two groups ofpatients: Group I: venous access only (no arterial access, n=102)and Group II: conventional double vascular access (arterialand venous access, n=275). Methods and Results The baseline characteristics of the two groups were comparablefor age, sex, clinical, echo-cardiographic, radiological andhaemodynamic variables. The mitral valve area (Group I: 1·1±0·3to 1·85±0·5cm²vs Group II: 1·05±0·2to 1·85±0·5cm², P=ns) and transmitral gradient(Group I: 11±4 to 4·7±2mmHg vs Group II:12±4 to 4·8±2mmHg, P=ns) before and aftermitral valvuloplasty were not statistically different. A goodimmediate result, defined as mitral valve area >1·5cm²andmean mitral gradient <5mmHg with mitral regurgitation 2+at the end of the procedure, was observed in 77% of the casesin the venous-only group and 79% in the double access group(P=ns). The incidence of severe mitral regurgitation (GradeIII or IV) was not statistically significant. Procedural duration(71±24min vs 109±26min, P<0·01), fluoroscopictime (12·5±5·5min vs 18·5±6min,P<0·01) and hospital stay (2·8±15 daysvs 4·8±2·6 days, P<0·001) weresignificantly shorter in the venous-only group than in the conventionalInoue series. Conclusion Single venous access balloon mitral valvu-loplasty is as equallysafe and effective as double vascular access. The additionaladvantages of single venous access are shorter procedural duration,fluoroscopic time and hospital stay. We recommend that it beperformed by an experienced operator (minimum of 100 trans-septalpunctures) in patients without major thoracic deformity anda good echogenic window.     

Conduction disturbances related to percutaneous balloon mitral valvuloplasty

During the performance of 280 consecutive percutaneous balloon mitral valvuloplasty operations, two cases of conduction disturbances were reported (0.7%). These rare complications are transient and due to the mechanical pressure of the balloon on the conduction system.