肺静脉隔离联合经皮球囊二尖瓣成形术治疗风湿性二尖瓣狭窄伴长程持续性心房颤动

目的:评估肺静脉隔离（PVI）联合经皮球囊二尖瓣成形术（PBMV）治疗风湿性二尖瓣狭窄伴长程持续性心房颤动（LSPAF）的有效性及安全性。方法:入选2012年7月至2019年7月在徐州市中心医院接受PVI联合PBMV治疗的风湿性二尖瓣狭窄伴LSPAF的患者11例,其中男2例,年龄（58.2±10.0）岁,在三维电解剖系...     

经皮肺动脉瓣成形术治疗肺动脉瓣狭窄的临床分析

目的:探讨应用Inouc球囊经皮肺动脉瓣成形术(PBPV)治疗肺动脉瓣狭窄(PVS)的临床疗效。方法:PVS 患者18例,采用PBPV进行治疗,并以超声多普勒评价其疗效。结果:18例行PBPV患者术后即刻右心室收缩压由 (101．4±28．2)mmHg降至(48．5±16．7)mmHg(P<0．01)。右房压由(16．9±7．5)mmHg降至(9．8±4．3)mmHg (P<0．05),肺动脉压由(15．2±3．1)mmHg升至(23．1±5．6)mmHg(P<0．05),肺动脉与右心室跨瓣压差 (△P)由(76．5±25)mm Hg降至(21．7±12．2)mmHg(P<0．01)。多普勒超声随访:术后3个月跨瓣压差较术后即刻进一步显著下降(P<0．05)。结论:经皮球囊肺动脉成形术治疗肺动脉瓣狭窄安全有效。     

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治疗风湿性二尖瓣狭窄疗效的初步探讨

【】目的 探讨经皮球囊二尖瓣成形术( PBMV) 治疗风湿性二尖瓣狭窄患者的近期疗效。方法 将我院2013 年9 月-2016 年01月14 例应用PBMV治疗的风湿性二尖瓣狭窄患者按照年龄分为A组(年龄＜60岁)、B组(年龄≥60岁),两组分别用心导管测定患者PBMV 前后的左心房压力、肺动脉压力,心脏超声评价PBMV 前后二尖瓣口面积、二尖瓣口血流速度、二尖瓣反流面积及左房内径、左室舒张末径、右房内径、右室舒张末径、左室每搏输出量、左室射血分数等指标。将两组数据进行统计分析。结果 PBMV成功率100%,无围手术期并发症及死亡病例。A组、B组在PBMV 前、后所有参数比较均无统计学意义(P＜0.05)。结论PBMV 治疗风湿性二尖瓣狭窄有效,高龄患者(≥60岁)亦可以从该术式获益。     

经皮二尖瓣球囊成形术治疗老年二尖瓣狭窄的近期疗效

目的探讨老年风湿性心脏病(RHD)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32例老年风湿性心脏病MS患者进行PBMV并对结果进行分析。结果术后肺动脉平均压、左房平均压、二尖瓣跨瓣压显著下降(P0.001),超声心动图检查示二尖瓣口面积显著扩大(P0.001),心排量明显增加(P0.05),左室射血分数显著上升(P0.001),操作相关并发症少。结论PBMV治疗老年风湿性心脏病MS患者近期疗效好,成功率高,严重并发症少。     

纤维纵隔炎致肺血管狭窄的诊治进展

纤维纵隔炎是一种罕见的纵隔内纤维组织良性增生性疾病,但严重时也可危及生命。由于其临床症状缺乏特异性,容易误、漏诊。纤维纵隔炎导致的肺血管狭窄可引起肺高血压和右心衰竭,临床上缺乏有效的治疗手段。近年发现,经皮肺血管介入治疗纤维纵隔炎导致的肺血管狭窄疗效显著。该文对纤维纵隔炎导致肺血管狭窄的流行病学、病理生理学特点、临床表现、诊断标准和治疗手段进行了综述。同时,结合甘肃省人民医院对于该病的诊治经验,总结了纤维纵隔炎的特征性临床表现(纤维纵隔炎二联征、三联征),并针对纤维纵隔炎导致肺血管狭窄的临床分型和诊断流程提出了建议。     

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～     

经皮二尖瓣球囊成形术治疗二尖瓣狭窄伴主动脉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)合并轻、中度主动脉瓣关闭不全 (AR)患者行经皮二尖瓣球囊成形术 (PBMV)的效果。方法　将 2 6例MS合并轻、中度AR患者 (A组 )和 34例单纯MS患者 (B组 )的PBMV术后即刻及随访结果作对比研究。结果　A组左心房平均压力(MLAP)从术前 2 3 5± 4 6mmHg降至 11 2± 2 9mmHg(P <0 0 1) ,二尖瓣跨瓣压差 (MVG)从 17 2±7 7mmHg降至 2 3± 2 6mmHg(P <0 0 1) ,二尖瓣口面积 (MVA)从 1 1± 0 2cm2 增至 2 1± 0 2cm2(P <0 0 1) ,左心房内径 (LAD)从 43 3± 5 0mm降至 36 4± 3 7mm(P <0 0 1)。二尖瓣区舒张期杂音消失率为 73%。心功能分级 (NYHA)从术前 2 7± 0 5级改善至 1 1± 0 7级 (P <0 0 1)。随访与术后比较 ,除MVA外各项指标均无显著性差异 (P >0 0 5 )。以上各项参数与B组比较 ,差异均无显著性(P >0 0 5 )。且A组随访左心室内径 (LVD)仍在正常范围 ,亦无主动脉瓣返流增加。结论　对于MS合并轻、中度AR ,PBMV是一种有效和安全的治疗措施 ,应列入PBMV的手术适应症。     

经皮球囊成形术治疗先天性主动脉瓣下狭窄1例

1病例报告患者,女,16岁,因“发现心脏杂音10年,反复活动后头晕、乏力5年”入院,10年前因心脏杂音,经检查诊断为“先天性主动脉瓣下狭窄（discrete membranous subaortic stenosis,DMSS）”,未作特殊处理,近年逐渐出现活动后头晕并有晕厥前兆表现。     

Comparison of stent versus balloon angioplasty for pulmonary vein stenosis complicating pulmonary vein isolation

Introduction: Pulmonary vein stenosis (PVS) is a rare but significant complication of pulmonary vein isolation (PVI). Dilation and stent angioplasty have been described but not compared.
Methods and Results: All percutaneous interventions for PVS complicating PVI between December 2000 and March 2007 were reviewed. Acute success, defined as post-intervention stenosis ≤30%, and long-term outcome of dilation versus stent angioplasty were compared. Freedom from restenosis was defined as freedom from repeat intervention. Overall outcome for all interventions was examined. We studied 34 patients with 55 stenotic veins followed for a mean of 25 months. Dilation was performed in 39 veins and stenting in 40 veins (16 primarily, 24 after dilation restenosis). Acute success and restenosis rates were 42% and 72% for dilation versus 95% (P < 0.001) and 33% for stenting. Time to restenosis was greater for stent angioplasty (P = 0.003). Stents ≥10 mm in diameter had lower restenosis than smaller stents. Risk factors for restenosis included small reference vessel diameter and longer time from PVI to intervention for PVS. All but two patients experienced improvement (n = 10) or resolution of symptoms (n = 22). The mean percent stenosis decreased from 82% to 21% for the entire cohort and mean flow to the lung quadrant increased from 10% to 17%.
Conclusion: Stent angioplasty results in less restenosis than dilation, particularly for stents ≥10 mm. Early referral may improve long-term patency by minimizing reference vessel atrophy. Most patients with PVS post-PVI can be improved symptomatically with catheter intervention.     

Catheter based treatments for fibrosing mediastinitis

Fibrosing mediastinitis is a rare, often debilitating and potentially lethal disease characterized by an exuberant fibroinflammatory response within the mediastinum. Patients typically present with insidious symptoms related to compression of adjacent structures including the esophagus, heart, airways, and cardiac vessels. Fibrosing mediastinitis is most often triggered by Histoplasmosis infection; however, antifungal and anti‐inflammatory therapies are largely ineffective. While structural interventions aimed at alleviating obstruction can provide significant palliation, surgical interventions are challenging with high mortality and clinical experience with percutaneous interventions is limited. Here, we will review the presentation, natural history, and treatment of fibrosing mediastinitis, placing particular emphasis on catheter‐based therapies.     

Comparison of conventional and cutting balloon angioplasty for congenital and postoperative pulmonary vein stenosis in infants and young children

Background: Pulmonary vein stenosis (PVS) is a rare and often lethal condition in children. The optimal treatment for congenital and postoperative PVS is unknown. Methods and Results: We compared outcomes of conventional balloon angioplasty performed for PVS from 1999 to 2003 against cutting balloon angioplasty performed from 2004 to 2007. A total of 100 previously undilated pulmonary veins in 54 patients were studied: 48 veins dilated with conventional balloons and 52 with cutting balloons. Acute results included significantly reduced gradients and increased lumen diameters with both treatments. Acutely, cutting balloon angioplasty and conventional angioplasty yielded similar relative reduction of the PVS gradient (median 78% vs. 63%, P = 0.08) and increase in lumen diameter (median 77% vs. 59%, P = 0.07). There was one procedural death of a critically ill infant, and four cardiac arrests, but no adverse events necessitating surgical intervention. Survival free from reintervention was poor in both groups, and shorter in the cutting balloon group (73% at 1 month, 11% at 6 months, and 4% at 1 year) than in the conventional angioplasty group (77% at 1 month, 35% at 6 months, and 23% at 1 year; P = 0.01). Conclusions: Both conventional and cutting balloon angioplasty were effective at decreasing gradient and increasing lumen size acutely in patients with congenital and postoperative PVS, but reintervention was common with both treatments. Both methods of angioplasty provided limited benefit, and neither was curative for this complex disease. © 2010 Wiley‐Liss, Inc.     

经皮腔内肺动脉成形术治疗慢性血栓栓塞性肺动脉高压的有效性及安全性评估

目的评估经皮腔内肺动脉成形术(PTPA)治疗慢性血栓栓塞性肺动脉高压(CTEPH)患者的有效性和安全性。方法该研究为前瞻性单臂试验。纳入2017年1月至2019年6月武汉亚洲心脏病医院心外科确诊的CTEPH患者。以明确诊断CTEPH的时间为基线, 收集入选患者的基线临床资料, 包括年龄、性别、世界卫生组织(WHO)功能分级、6 min步行距离、N末端B型利钠肽原(NT-proBNP)水平以及右心导管测定的血流动力学指标等。患者分次行PTPA, 统计每位患者扩张血管数, 术后24周随访并复查右心导管。记录手术安全性指标, 包括全因死亡、围术期并发症、再灌注肺水肿等。结果共入选患者19例, 年龄(56.3±12.5)岁, 男性7例。入选患者分别进行了1～7次PTPA, 总计56次, 累计扩张肺动脉260支, 每次扩张血管(5.14±2.36)支。共13例患者测定了6 min步行距离, 为(307±130)m。入选患者PTPA术后均自述体力明显改善, 尤其以第一次手术后为著。PTPA术后24周, 入选患者平均肺动脉压由基线的(40.11±7.55)mmHg(1 mmHg=0.133 kPa)...     

Percutaneous pulmonary vein stenosis angioplasty complicated by rupture: Successful stenting with a polytetrafluoroethylene‐covered stent

A 47‐year‐old‐man with prior pulmonary vein (PV) isolation for atrial fibrillation developed progressive shortness of breath and was found to have total occlusion of the left lower and significant stenosis in left upper PV. A ventilation/perfusion scan showed decreased left lung perfusion. Percutaneous PV stenosis angioplasty was complicated by the rupture of left lower PV with pericardial tamponade; successful stenting with a polytetrafluoroethylene‐covered stent was performed. Follow‐up studies at nine months showed patency of both veins with a normal ventilation perfusion scan. In this article, we will discuss acquired PV stenosis following PV isolation, percutaneous PV intervention, and the literature supporting the procedure. © 2014 Wiley Periodicals, Inc.     

A rare cause of pulmonary hypertension: Idiopathic fibrosing mediastinitis obstructing right pulmonary artery and pulmonary veins

Fibrosing mediastinitis is caused by a proliferation of fibrous tissue in the mediastinum with encasement of mediastinal viscera and compression of mediastinal bronchovascular structures. Pulmonary hypertension (PH) may occur as a severe complication of the disease. Herein, we report a patient diagnosed with fibrosing mediastinitis and pulmonary hypertension, whose imaging tests showed obstruction of right pulmonary artery and veins.     

Pulmonary vein stenosis: Etiology,diagnosis and management

Pulmonary vein stenosis(PVS) is rare condition characterized by a challenging diagnosis and unfavorable prognosis at advance stages. At present, injury from radiofrequency ablation for atrial fibrillation has become the main cause of the disease. PVS is characterized by a progressive lumen size reduction of one or more pulmonary veins that, when hemodynamically significant, may raise lobar capillary pressure leading to signs and symptoms such as shortness of breath, cough, and hemoptysis. Image techniques(transesophageal echocardiography, computed tomography, magnetic resonance and perfusion imaging) are essential to reach a final diagnosis and decide an appropriate therapy. In this regard, series from referral centers have shown that surgical and transcatheter interventions may improve prognosis. The purpose of this article is to review the etiology, assessment and management of PVS.