二尖瓣闭式分离术后再狭窄的球囊成形术及远期疗效

本文对１７例经皮穿刺二类瓣球囊成形术（ＰＢＭＶ）治疗二尖瓣式分离术后再狭窄者作了长期随诊观察。随谬时间１５－５４个月（平均３１．６±１４．６月）。术前，术后及胡记时二尖瓣瓣口面积分别为１．１１±０．２３、１．８６±０．２１、１．７６±０．３８ｃｍ＾２。随访时１６例心功能持续改善，３例超声心动力图检查二尖瓣口发生了再狭窄，１例心展望气短症状复发。研究结果表明，ＰＢＭＶ治疗二尖瓣才式分离术后再狭窄安全     

114例经皮二尖瓣球囊成形术病人8年远期疗效观察

目的:评价经皮二尖瓣球囊成形术(PBMV)治疗风湿性二尖瓣狭窄的8年疗效。方法:1994年9月～2002年10月,对114例患者采用Inoue法作PBMV,术后每年至少随访1次,作超声心动图检查以及心功能评价。结果:PBMV术后二尖瓣瓣口面积显著增大,为(0.76±0.12)cm~2和(2.01±0.21)cm~2,P<0.01;8年后为(1.55±0.14)cm~2,P<0.01;发生再狭窄40例,发生率为35％。结论:PBMV术后8年治疗结果令人满意。     

二尖瓣闭式分离术后再狭窄的经皮球囊成形术疗效观察

目的：研究闭式分离术后再狭窄患者经皮二尖瓣球囊成形术（ＰＢＭＶ）治疗近期和远期疗效及其影响因素。　方法：对经ＰＢＭＶ治疗的二尖瓣闭式分离术后再狭窄患者３３ 例与无外科手术史的二尖瓣狭窄患者（３１３ 例）进行比较,并随访观察。　结果：ＰＢＭＶ治疗后临床症状明显改善,二尖瓣外科术后再狭窄患者瓣口面积（ＭＶＡ）由（１．０３±０．２８）ｃｍ ２ 增至（１．９４±０．２７）ｃｍ ２ （Ｐ＜ ０．００１）,原发性二尖瓣狭窄者瓣口面积由（１．１２±０．４５）ｃｍ ２ 增至（２．２２±０．２６）ｃｍ ２ （Ｐ＜ ０．００１）,血流动力学两组无显著差异。其中１９例随访（４．３±２．１）年,ＭＶＡ 为（１．８１±０．２７）ｃｍ ２（与术前比较,Ｐ＜ ０．００１,与术后即刻比较,Ｐ＞ ０．０５）,发生再狭窄３例,已成功行第二次ＰＢＭＶ。　结论：ＰＢＭＶ治疗闭式分离术后再狭窄近期、远期疗效显著,具有创伤小、安全、有效、可重复性的特点,可避免或推迟外科手术。     

再次经皮球囊二尖瓣成形术临床效果观察

目的观察再次经皮球囊二尖瓣成形术(PBMV)治疗PBMV后二尖瓣再狭窄的临床效果。方法 82例PBMV后二尖瓣再狭窄的病人,再次采用我科小弧度法PBMV治疗,并进行近远期疗效随访。结果 82例病人经再次PBMV治疗后,成功78例,成功率为95.1%。术后病人左心房平均压、二尖瓣口面积、跨瓣压差、肺动脉收缩压明显改善,与术前比较差异有显著性(t=2.35~4.76,P均<0.05);而左心房内径无明显改变(t=1.54,P>0.05)。78例病人术后随访(76±23)个月,结果二尖瓣口面积仍明显大于再次PBMV术前,跨瓣压差明显小于再次PBMV术前(t=2.16~3.68,P<0.05),且与术后即刻结果比较差异均无显著性(t=1.24~1.59,P均>0.05),大多数病人临床症状和生活质量明显改善。结论对于PBMV后再狭窄的病人,只要病例选择适当,手术操作正确,再次PBMV后即刻及远期疗效好。     

经皮二尖瓣球囊成形术治疗风心病二尖瓣狭窄并中度返流的临床研究

目的　探讨评价二尖瓣狭窄 (MS)并中度返流 (MR)患者经皮二尖瓣球囊成形术 (PBMV)近、远期疗效。方法　采用简化改良 lnoue法对 2 5例风心病二尖瓣狭窄并中度返流者行 PBMV治疗 ,并进行术后随访 ,包括临床症状、心尖部舒张期杂音、心功能、超声心动图检测二尖瓣口面积判断近、远期疗效。结果　超声心动图 (UCG)二尖瓣瓣膜评分≤ 8分 ,PBMV术后二尖瓣瓣口面积由 0 .83± 0 .2 1cm2 增至 1.98± 0 .2 6 cm2 (P<0 .0 1) ;心功能由 2 .80± 0 .2 4级增至1.5 0± 0 .4 0级 (P<0 .0 1)。 UCG二尖瓣瓣膜评分 >8分 ,PBMV术后二尖瓣瓣口面积由 0 .80± 0 .2 2 cm2 增至 1.98±0 .2 6 cm2 (P<0 .0 1) ;心功能由 2 .82± 0 .2 4级增至 2 .30± 0 .4 0级 (P<0 .0 1)。结论　风心病二尖瓣狭窄并中度返流、瓣膜条件好者 ,PBMV近、远期疗效满意 ,未见严重并发症。     

经皮球囊导管二尖瓣成形术治疗风湿性二尖瓣狭窄的临床疗效

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)的临床疗效。方法采用Inoue法对336例风湿性MS患者行PBMV。结果术后左房平均压由3.06±1.04kPa降至1.87±0.77kPa,二尖瓣跨瓣压差由2.11±0.21kPa降至0.8±0.08kPa,二尖瓣口面积由0.96±0.32cm     

二尖瓣球囊成形术对血流动力学变化的影响

目的明确不同心律和瓣口大小条件时二尖瓣球囊成形术(PBMV)的效果及左房压和肺动脉压改善的情况。方法110例患者PBMV术前及术后即刻分别用常规心导管法测肺动脉压和左房压;术前及术后第3天彩色多普勒测二尖瓣口面积。结果PBMV术后二尖瓣口面积显著扩大,较术前增加约70%;术后即刻肺动脉压和左房压分别下降(14.23±11.04)mmHg和(9.43±6.32)mmHg;合并心房纤颤者,后者改善较窦性心律者差(P=0.017和P=0.041),但瓣口面积的改善两者无差异。不同的狭窄程度对手术效果无显著的影响。结论成功的二尖瓣球囊成形术能显著改善血流动力学。     

经皮球囊二尖瓣成形术70例疗效分析

目的　了解经皮球囊二尖瓣成形术治疗风湿性心脏病二尖瓣狭窄的疗效。方法　对70例风湿性二尖瓣狭窄接受PBMV治疗的患者进行回顾性分析。运用超声心动图对二尖瓣活动度、增厚度、钙化度、瓣下病变进行评分，同时检测瓣口面积、二尖瓣跨瓣压差。结果　显示PBMV前后二尖瓣瓣口面积、二尖瓣平均跨瓣压差、左房平均压力差异显著(P＜0.05)；52例随访，平均瓣口面积较术后略有缩小(P＞0.05)，无再狭窄发生；对63例进行二尖瓣病变超声评分，总评分≤8分组PBMV效果好于总评分＞8分组。结论　PBMV是治疗风湿性二尖瓣狭窄的有效方法。     

经皮球囊二尖瓣扩张术后临床观察

目的 :对经皮二尖瓣球囊扩张术 (PBMV)后病人随访资料作了回顾性分析 ,以确定再狭窄率、远期疗效及其影响因素 ;方法 :对 1 997年 9月至 2 0 0 0年 5月随访资料完整的2 4例患者进行了回顾性研究 ,其中 ,男 1 0例 ,女 1 4例 ,年龄 (4 4.87± 1 2 .91 )岁。随访时间(1～ 33)个月 ,平均 (1 7.2 9± 1 0 .1 )个月 ;结果 :术后左房平均压由 (3.2 7± 1 .0 6)kPa降至 (1 .37± 0 .78)kPa ,跨瓣压差由 (2 .65± 1 .31 )kPa降至 (0 .76± 0 .49)kPa ,二尖瓣口面积由 (1 .1 3± 0 .1 9)cm2 增加至 (1 .97± 0 .35 )cm2 。 4例 (1 6.7% )发生再狭窄 ;结论 :PBMV术后远期疗效良好。术前超声心动图计分、有无房颤、左房压为长期疗效的预测因素。     

分离术后再狭窄的二尖瓣球囊成形术

应用经皮穿刺球囊二尖瓣成形术（ＰＢＭＶ）治疗４例外科闭式分离术后再狭窄患者，ＰＢＭＶ术后，二尖瓣口面积扩大，左房平均压下降，二尖瓣平均跨瓣压差下降，心功能明显改善恢复。随访２～３年，心功能持续改善，二尖瓣口面积不变或增大，说明ＰＢＭＶ治疗外科闭式分离术后再狭窄患者是一种安全有效的方法。     

Role of closed mitral commissurotomy for mitral restenosis

Out of 1184 consecutive cases of rheumatic mitral stenosis treated surgically by closed mitral commissurotomy (CMC) at NRS Medical College and Hospital, Calcutta, 20 (1.68%) were mitral valve restenosis. Twelve cases (60%) were females, The median age was 32 years. Duration between the first operation and reappearance of symptoms varied with a mean of 8 years. The previous operations were digital dilatation and instrumental dilatation in 6 and 14 cases respectively. History of thromboembolism was present in 4 cases. On echocardiography, calcification of the mitral valve was present in 2 cases, left atrial clot in 4 cases, associated mild to moderate mitral regurgitation in 6 cases and mild aortic regurgitation in 4 cases. All cases presented with New York Heart Association (NYHA) III and IV symptoms. Critical stenosis (mitral valve orifice less than 0.5 cm2) was present in 12 cases. Re-do CMC was undertaken in all cases with Tubb's dilator. Median operating time was 2.5 hours. Satisfactory split was achieved in 13 cases. One patient died during surgery. Four cases having less than satisfactory split were asymptomatic on follow-up. In one case no split was possible and in another, gross mitral regurgitation was noted postoperatively. These 2 cases had to undergo open heart surgery. It is concluded that re-do CMC is a feasible and suitable alternative in mitral restenosis even in the presence of complications.     

二尖瓣成形术治疗二尖瓣关闭不全的临床研究

目的总结25例二尖瓣关闭不全患者行二尖瓣成形术的手术方法及效果。方法患者均在全麻低温体外循环下施行,采用瓣叶切除修复、瓣裂修复、交界缝合、腱索缩短、双孔二尖瓣成形、人工瓣环植入。手术前、后应用食道内超声心动图判断二尖瓣反流的原因和部位及手术治疗效果,术中采用左室注水加压试验初步判断二尖瓣成形的效果。术后随访主要依靠超声心动图。结果围术期死亡1例,死于恶性心律失常。术后心脏彩超显示,15例(60.00%)无二尖瓣返流,9例(36.00%)为轻微～轻度返流,左房、左室较术前明显缩小,心功能较术前明显改善。结论严格掌握手术适应征,针对不同瓣膜病变,运用合理的瓣膜成形技术,行二尖瓣外科修复疗效确切,术中左室注水试验及经食道超声心动图可为二尖瓣成形提供良好的技术支持。     

“钮扣状”转移保留二尖瓣全装置瓣膜置换的初步探讨

目的 :探讨二尖瓣狭窄病人采用“钮扣状”转移保留全瓣装置二尖瓣置换的方法及对左心功能的影响。方法 :对 5 6例二尖瓣狭窄需行二尖瓣置换的患者 ,分为 :A组 (术中“钮扣状”保留全部二尖瓣瓣下结构 ) ,B组(术中仅保留二尖瓣后瓣及瓣下结构 )和C组 (术中未保留瓣下结构 ) ;于术前 ,术后监测血流动力学指标 ;术前、术后出院前、术后 3～ 6个月行超声心动图检查 ,监测心功能指标。结果 :A组术后心排指数、每搏指数、左室收缩功指数、肺毛细血管楔压、左室舒张末、收缩末内径、左室射血分数、短轴缩短率及左室长轴舒张末内径均优于B ,C组 ,且EF值恢复优于B ,C组。A组主动脉阻断时间较B ,C组延长 ,但总转流时间比较 ,差异无显著性 (P >0 .0 5 )。结论 :以二尖瓣狭窄为主的病人行瓣膜置换时可采用“纽扣状”转移保留全部瓣下装置 ;病人术后早期心功能的改善优于部分保留组和不保留组。     

142例二尖瓣关闭不全患者行二尖瓣修复成形术的手术经验

目的　分析、总结 14 2例行二尖瓣修复成形术的二尖瓣关闭不全患者的临床疗效。方法　 1994年 1月～ 2 0 0 3年 12月 ,连续对 14 2例二尖瓣关闭不全患者行修复成形术 ,男 88例 ,女 5 4例 ,平均年龄为 (38.5± 7.8)岁。病因诊断 :二尖瓣腱索断裂 74例 ,二尖瓣黏液变性伴瓣叶脱垂 36例 ,冠心病二尖瓣乳头肌功能不全15例 ,二尖瓣瓣环扩大 11例 ,感染性心内膜炎伴二尖瓣穿孔 4例 ,扩张型心肌病伴二尖瓣关闭不全 2例 ;7例患者合并非风湿性主动脉瓣病变。手术在体外循环、中低温下施行 ,采用瓣叶切除缝合、瓣环成形、穿孔修补、腱索转移、edgetoedge技术及人工腱索成形技术 ,术中以食道超声监测成形效果。 结果　死亡 2例 ,1例术后第 6天死于脑出血 ,另 1例术后第 5天死于多器官功能衰竭。 5例患者术中转为瓣膜置换手术 ;其余患者术毕二尖瓣无返流或轻度返流。在平均为 (34.5± 4 .8)个月的随访中 ,有 2例二尖瓣返流加剧至中度而行二尖瓣置换手术。其余患者二尖瓣返流未见加剧 ,心功能恢复良好。结论　选择适当的患者、运用合理的瓣膜成形技术 ,二尖瓣关闭不全患者行瓣膜成形术可取得满意的疗效。     

“钮扣状”转移保留二尖瓣全装置瓣膜置换的初步探讨

OBJECTIVE: To evaluate the surgical technique and the effect of preservation of the entire mitral subvalvular apparatus during mitral valve replacement (MVR) in patients with mitral stenosis. METHODS: MVR was performed on 56 patients with mitral stenosis. Of them, 11 had complete preservation of the entire mitral subvalvular apparatus (group A) with the technique of preservation of 'button-shaped' transplantation, 25 had the preservation of the posterior leaflet only (group B), and the other 20 underwent the conventional MVR (group C). Pre- and postoperative hemodynamic parameters were measured to determine the left ventricular performance. Echocardiography was performed preoperatively, at the time of discharge, and 3 to approximately 6 months postoperatively to determine the dimensions and ejection function. RESULTS: Cardiac index, stroke volume index and left ventricular stroke work index postoperatively in group A were better than those in group B and C (P < 0.05). Echocardiographic measurements postoperatively showed the increase of LVESD, LVEDD in group B and C, but a better LVL and LVFS in group A (P < 0.05), and LVEF was more pronounced in group A (P < 0.05). There appeared a long cross-clamp time in group A, but the total CPB time was not significant among the three groups. CONCLUSION: The surgical skills of preservation with 'button-shaped' transplantation may be a practical choice for patients with mitral stenosis. The preservation of entire mitral subvalvular apparatus improves the left ventricular functions after MVR in patients with mitral valve stenosis.     

A comparative study of balloon mitral valvuloplasty and closed mitral commissurotomy in patients with rheumatic mitral stenosis

Rheumatic mitral stenosis is frequently encountered in our country. It affects younger population and is a major cause of morbidity Mitral valvotomy is the definitive therapy for this disease and can be achieved by closed mitral commissurotomy (CMC), open mitral commissurotomy (OMC) or by percutaneous transluminal mitral valvuloplasty (PTMV). Compared to CMC, PTMV is less invasive but more expensive at this moment. With the reduction of cost, PTMV may become the procedure of choice for the treatment of rheumatic mitral stenosis in future.     

Non-surgical mitral valvotomy

Percutaneous transseptal mitral valvotomy was performed on 14 occasions in 13 patients; in one patient, the procedure was unsuccessful at the first attempt, but was repeated successfully. All other attempts were successful, giving a procedure success rate of 93% and a patient success rate of 100%. The only complication was transient diplopia in one patient, presumably due to a small cerebral embolus. This early experience confirms that this procedure is easily learnt, and can be performed with good results and low risk in selected patients with mitral stenosis.