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.     

风湿性心脏病合并心房颤动经皮球囊二尖瓣成形术远期疗效观察

目的:观察心房颤动患者经皮球囊二尖瓣成形术的远期疗效。方法:318例风湿性心脏病二尖瓣狭窄合并持续性或永久性心房颤动患者,在充分抗凝治疗后,全部采用改良Inoue法行经皮球囊二尖瓣成形术,并进行远期随访。结果:318例心房颤动患者经皮球囊二尖瓣成形术成功296例,成功率为93.1%。失败22例,其中仅1例患者术中发生脑动脉栓塞。经皮球囊二尖瓣成形术术后左心房平均压、左心房内径、二尖瓣口面积、跨瓣压差及肺动脉收缩压较术前差异均有统计学意义(P0.05～0.01)。108例患者经皮球囊二尖瓣成形术后平均随访75±26(12～146)个月,术后远期随访可见二尖瓣口面积仍明显大于术前,跨瓣压差及左心房内径明显小于术前,近期随访结果均与远期随访结果相近似,亦明显小于术前,差异均有统计学意义(P0.05)。结论:二尖瓣狭窄合并持续性或永久性心房颤动患者,经过充分的抗凝治疗后,施行经皮球囊二尖瓣成形术是安全的;且其近期和远期疗效皆佳,值得临床推广。     

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 .     

经皮二尖瓣球囊扩张术治疗老年人二尖瓣狭窄的临床观察

目的 探讨经皮二尖瓣球囊扩张术(PBMV)治疗老年人二尖瓣狭窄的疗效、安全性及并发症的预防.方法 采用改良的房间隔定位法及运用跨二尖瓣技术对老年二尖瓣狭窄患者行逐步球囊扩张.手术前后分别记录即刻左心房压、肺动脉平均压、二尖瓣跨瓣压差及二尖瓣口面积,并进行手术后随访.结果 PBMV有效扩大了二尖瓣口面积,与术前比较,术后左心房压下降[分别为(25.3±6.7)mm Hg(1 mm Hg=0.133 kPa)与(16.4±5.8)mm Hg]、二尖瓣跨瓣压下降[分别为(17.6±6.7)mm Hg与(6.8±2.9)mm Hg]、肺动脉压下降[分别为(38.6±12.1)mm Hg与(29.2±9.8)mm Hg],二尖瓣口面积增加[分别为(1.05±0.22)cm2与(1.61±0.38)cm2],心功能明显改善,差异均有统计学意义(P＜0.05或P＜0.01).随访结果表明,PBMV疗效稳定.结论 PBMV操作技术的改进能明显改善老年患者二尖瓣狭窄症状,显著降低手术的并发症.

Abstract：

Objective To evaluate the efficacy and safety of the improved percutaneous balloon mitral valvuloplasty (PBMV) in elderly patients with mitral stenosis. Methods Elderly patients with severe mitral stenosis received an improved PBMV which included a modified way of atrial septal puncture and technique across the mitral valve. The left atrial pressrue (LAP), mean pulmonary pressure (MPA), mean gradient across the mitral value (MPG) and mitral valve area (MVA) were recorded and compared before and after the operation. Long term follow up were made. Results After operation, the LAP decreased [(25.3±6.7) mm Hg vs.(16.4±5.8) mm Hg,1 mm Hg=0.133 Kpa], MPG decreased [(17.6±6.7) mm Hg vs.(6.8±2.9) mm Hg], MPA decreased [(38.6±12.1) mm Hg vs. (29.2±9.8) mm Hg], MVA increased [(1.05±0.22)cm2 vs.(1.61±0.38)cm2] and the New York heart association heart function classification improved. The follow-up result showed that the effect of PBMV was constant. Conclusions Improved PBMV may be an effective and safe measure for patients with mitral stenosis.     

二尖瓣球囊成形术在二尖瓣狭窄合并左房血栓形成中的应用

目的:评价经皮二尖瓣球囊成形术治疗二尖瓣狭窄伴左房血栓形成的疗效、安全性。方法:56例伴有左房血栓形成患者术前经正规华法林抗凝治疗后,采用改良的房间隔定位法即井字定位法及运用跨二尖瓣技巧对二尖瓣狭窄伴左房血栓形成患者行逐步球囊扩张,以血流动力学评估手术前后即刻左房压、二尖瓣跨瓣压差及二尖瓣口面积,并进行手术后随访,观察有无体循环血栓栓塞等并发症。结果:与术前相比较,术后左心房平均压下降[(21.6±3.7)mmHg(1mmHg=0.133kPa)∶(35.1±4.2)mmHg]、二尖瓣跨瓣压差显著下降[(7.1±3.1)mmHg∶(16.8±4.5)mmHg)],二尖瓣口面积增大[(1.65±0.28)cm2∶(0.71±0.14)cm2],差异极有统计学意义(均P<0.01),心功能明显改善。超声心动图随访结果表明,经皮二尖瓣球囊成形术疗效稳定,无血栓栓塞并发症发生。结论:左房血栓形成仅为经皮二尖瓣球囊成形术的相对禁忌证,对于经充分华法林抗凝治疗的患者而言,经皮二尖瓣球囊成形术操作技术的改进能明显改善其症状,是安全有效的。     

经皮球囊二尖瓣并三尖瓣成形术及远期疗效观察

目的：对风湿性二尖瓣狭窄合并三尖瓣狭窄患者行经皮球囊成形术,观察其远期疗效。方法：对8例患者行经皮球囊二尖瓣并三尖瓣成形术并长期随访。结果：8例患者术后进行长达6.2±3.9(2.0～10.5)年的随访,患者术后即刻及远期随访的临床症状及血流动力学指标均较术前明显改善,有极显著性差异(P＜0.01),而远期随访与术后即刻相近似(P＞0.05)；且无严重并发症及再狭窄发生。结论：风湿性二尖瓣狭窄合并三尖瓣狭窄患者,行经皮球囊成形术后,术后即刻及远期疗效均好,值得临床推广。     

单纯超声心动图引导下经皮二尖瓣球囊成形术的可行性及有效性研究

目的:评估单纯超声心动图引导下经皮二尖瓣球囊成形术(PBMV)的可行性。方法:对2016-10至2017-10间在本中心以单纯超声心动图引导下PBMV治疗风湿性重度二尖瓣狭窄的24例患者进行分析。所有患者于术后1、3、6及12个月门诊随访,行X线胸片、心电图和经胸超声心动图检查。结果:24例患者均在单纯超声心动图引导下成功施行了PBMV。术后经导管测二尖瓣跨瓣压差由(15.0±5.1)mm Hg(1 mmHg=0.133 kPa)降到了(6.7±2.9)mmHg(P0.01),超声心动图检测二尖瓣瓣口面积由(0.8±0.1)cm2增加到了(1.7±0.1) cm2(P0.01)。平均球囊直径为(26.7±1.2)mm。其中有8例患者术后出现二尖瓣轻度反流。平均随访时间为(7.4±3.1)个月。最后一次随访时,二尖瓣瓣口面积仍高达(1.6±0.1) cm~2,平均二尖瓣跨瓣压差为(9.0±4.3) mmHg。本组所有患者术后未出现心包积液或外周血管并发症。结论:单纯超声心动图引导下可以成功施行PBMV,其在避免了X线辐射及对比剂使用下仍然具有较高的安全性及有效性。     

经皮球囊二尖瓣成形术治疗伴巨大左心房的重度二尖瓣狭窄的临床研究

目的:评价经皮球囊二尖瓣成形术(PBMV)治疗风湿性心脏病(风心病)重度二尖瓣狭窄(MS)合并巨大左心房的可行性、安全性和有效性。方法:风心病重度MS合并巨大左心房患者共28例,其中男9例,女19例,年龄20～51(34.9±7.5)岁。采用常规及改良的非常规方法进行PBMV。以手术前后肺动脉平均压、左房平均压、二尖瓣跨瓣压差及左心房直径、二尖瓣口面积等血流动力学指标评估PBMV效果,并观察有无体循环血栓栓塞等并发症。结果:PBMV成功率为100%。与术前相比较,术后肺动脉平均压下降[(42.28±7.58)mmHg(1mmHg=0.133kPa)∶(23.17±5.99)mmHg]、左心房平均压下降[(28.11±6.18)mmHg∶(13.11±4.43)mmHg]、二尖瓣跨瓣压差显著下降[(19.55±6.14)mmHg∶(7.87±3.01)mmHg)],差异均具有统计学意义(P<0.001);同时左心房直径明显减小[(68.61±8.92)cm∶(51.39±7.88)cm]、二尖瓣口面积增大[(0.75±0.17)cm2∶(1.87±0.33)cm2],差异亦均具有统计学意义(P<0.01),心功...     

经皮二尖瓣球囊扩张术治疗二尖瓣狭窄伴中度返流

目的　探讨经皮二尖瓣球囊扩张术 (PBMV)治疗二尖瓣狭窄 (MS)伴中度二尖瓣返流(MR)的近、远期疗效。方法　采用自制二尖瓣球囊导管治疗MS伴中度MR患者 6 2例 ,其中二尖瓣膜明显增厚、钙化者 7例 ,对左室最大前后径、二尖瓣口面积、左房平均压、二尖瓣跨瓣压差及心功能(NYHA分级 )等主要指标随访观察 12～ 36个月。结果　术后二尖瓣口面积明显增大 [(0 83± 0 18)cm2 比 (1 86± 0 2 4 )cm2 ,P <0 0 1],左房平均压 [(32± 8)mmHg比 (13± 8)mmHg ,P <0 0 1,1mmHg=0 133kPa]及二尖瓣跨瓣压差 [(18± 9)mmHg比 (5± 3)mmHg ,P <0 0 1]明显降低 ,心功能明显改善 [(2 81± 0 2 4 )级比 (1 4 6± 0 37)级 ,P <0 0 1],左室最大前后径无显著改变 [(4 5± 4 )mm比 (4 6± 4 )mm ,P >0 0 5 ]。对左室最大前后径、二尖瓣口面积及心功能等指标随访观察 12～ 36个月均无明显改变。结论　选择合适病例 ,严格把握球囊扩张终点 ,风湿性二尖瓣狭窄并中度返流患者PBMV的近、远期疗效显著。     

重度二尖瓣狭窄合并左心房附壁血栓患者的经皮二尖瓣球囊成形术

对重度二尖瓣狭窄合并左心房附壁血栓的6例患者进行了经皮二尖瓣球囊成形术（PBMV）。结果均获得成功，无一例发生血栓栓塞性并发症，二尖瓣口面积由0．58±0．15cm2扩大到1．56±0．24cm2（P＜0．01），左房平均压由3．37±0．89kPa降至2．08±0．83kPa（P＜0．01），二尖瓣最大跨瓣压差由4．01±1．95kPa降至2．13±0．91kPa（P＜0．01）。心功能由Ⅳ级提高到Ⅲ级4例，Ⅱ级1例，Ⅲ级提高到Ⅱ级1例。我们认为，对已不能耐受外科手术的重度二尖瓣狭窄合并左房心耳部和侧壁的附壁血栓患者，在积极正确的术前准备、掌握好时机和操作熟练的前提下仍可进行PBMV。     

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.     

Comparison of clinical echocardiographic and hemodynamic characteristics of male and female patients who underwent mitral balloon valvuloplasty.

The clinical echocardiographic and hemodynamic characteristics and outcome of male and female patients before and after valvuloplasty were evaluated. The study population consisted of 34 male and 122 female consecutive patients who successfully underwent percutaneous balloon mitral valvuloplasty (PBMV). Clinical, echocardiographic, and hemodynamic variables were compared between male and female patients. Male patients were significantly older than female patients at the time of PBMV (39 years vs 34 years p < 0.05). Mitral valve score was significantly higher in male patients (p < 0.01). The mitral valve area before PBMV in male patients was significantly less than that in female patients (0.97 +/- 0.22 cm2 vs 1.09 +/- 0.25 cm2, respectively, p < 0.05). The pulmonary artery pressures of female patients before PBMV were higher than those of males (48 mm Hg vs 40 mm Hg, respectively, p < 0.05). The restenosis rates in male and female patients at the end of the follow-up period (38 months) were 20% and 9%, respectively (p < 0.05). In conclusion, male patients are older than female patients at the time of the PBMV procedure, and male patients have worse echocardiographic parameters and restenosis rates than female patients with the exception of pre-procedural pulmonary artery pressure.     

经皮二尖瓣球囊扩张术394例随访结果

目的　观察经皮二尖瓣球囊扩张术(PBMV)治疗风湿性心脏病(风心病)二尖瓣狭窄的中、远期疗效。方法　采用Inoue单球囊对680例风心病二尖瓣狭窄者行PBMV术治疗,其中394例进行了随访。平均随访时间(36±14)个月。结果　二尖瓣平均跨瓣压差由(18.2±6.8)mmHg降至(7.2±3.8)mmHg,瓣口面积由(1.04±0.21)cm2增至(1.98±0.55)cm2,左房内径由(44±8)mm降至(38±6)mm;8例出现明显再狭窄,其中5例再次PBMV术,3例行瓣膜置换术。结论　随访结果证实,PBMV治疗风心病二尖瓣狭窄的中、远期效果良好,瓣膜条件特别是瓣下病变的程度是影响中、远期疗效的重要因素。     

经导管封堵心脏人工瓣膜置换术后周围漏

目的 探讨经导管堵闭器封堵外科瓣膜置换术后人工瓣膜周围漏(PVL)的可行性、有效性和安全性.方法 回顾性分析外科瓣膜置换术后诊断为PVL的5例患者,其中主动脉瓣机械瓣置换术后PVL 2例,二尖瓣生物瓣置换术后PVL 2例,主动脉瓣和二尖瓣机械瓣置换术后二尖瓣PVL1例.封堵前后检查超声心动图以评价疗效.结果 患者均采用国产封堵器进行堵闭.2例主动脉瓣PVL封堵术后无残余;3例二尖瓣PVL堵闭术后残存微量至少量反流.其中1例主动脉瓣PVL患者介入术中出现心脏穿孔、心包填塞,经穿刺引流后痊愈.3例二尖瓣PVL患者出现术后早期溶血,于术后1～3周恢复.与术前比较,3个月随访期间左心室舒张末期内径减小[(52.2±6.8)mm比(61.1±7.2)mm,P＜0.05],肺动脉收缩压下降[(40.0±5.4)mm Hg(1 mm Hg=0.133 kPa)比(57.0±3.6)mm Hg,P＜0.05],二尖瓣PVL患者左心房内径减小[(49.0±4.3)mm比(56.0±6.3)mm,P＜0.05].结论 经导管封堵人工瓣置换术后PVL可行而且安全、有效,在具备适应证患者中可作为治疗选择.

Abstract：

Objective To evaluate the feasibility and efficacy of transcatheter closure of paravalvular leak (PVL) with Chinese-made occlder. Methods Five PVL patients were involved in this study, 2 out of the 5 patients underwent aortic mechanical valve replacements, 2 underwent mitral bioprosthetic valve replacements, and the remaining 1 underwent double mechanical valve replacement. Left ventricular end diastolic diameter, left atrial diameter and the systolic pulmonary artery pressure were assessed by echocardiography before and post the procedure. Results Complete occlusion without residual regurgitation was achieved in 2 patients with aortic PVL, for the 3 patients with mitral PVL, there was only tiny or mild mitral paraprosthetic leak remained post closure procedure. Cardiac perforation and pericardium tampenade occurred in 1 patient with aortic PVL during interventional closure and the patient recovered post emergent pericardiocentesis. Transient severe hemolysis and hemoglobinuria occurred in 3 patients with mitral PVL post closure procedure and they recovered after 1 to 3 weeks concervative therapy. During 3 months follow up, left ventricular end diastolic diameter [( 52. 2 ± 6. 8 ) mm vs. ( 61.1 ± 7.2 ) mm, P ＜0. 05], the systolic pulmonary artery pressure [(40. 0 ±5.4) mm Hg( 1 mm Hg =0. 133 kPa) vs. (57. 0 ±3.6) mm Hg, P ＜ 0. 05] and left atrial diameter of mitral PVL patient [( 49. 0 ± 4. 3 ) mm vs. ( 56. 0 ±6. 3) mm, P ＜ 0. 05] were significantly reduced compared to before closure procedure. Conclusion Percutaneous or transapical left ventricular access closure of PVL is feasible, effective and relative safe in selected patients.     

经皮球囊二尖瓣成形术前后一氧化氮、内皮素变化的研究

目的探讨风湿性心脏病二尖瓣狭窄患者经皮球囊二尖瓣成形术(PBMV)前后肺动脉及左心房血浆中内皮素(ET)、一氧化氮(NO)变化。方法选择符合行PBMV适应证的风湿性二尖瓣狭窄患者50例,PBMV术前及术后30min监测肺动脉压、左心房压,并同时取肺动脉血、左心房血分别用重氮法和放射免疫法测定NO和ET值及NO／ET值。结果PBMV术后,肺动脉压、左心房压明显下降,肺动脉平均压由((51．7±19．3)mmHg(1mmHg＝0．133kPa)降至(21．5±7．0)mmHg(P＜0．01),左心房平均压由(25．3±6．7)mmHg降至(13．2±9．7)mmHg(P＜0．01)。术前左心房血浆ET(51．1±10．6)pg/ml,NO(99．6±9．4)μmol／L,NO／ET=1．95±1．12;肺动脉血浆ET(131．1±19．3)pg/ml,NO(165．4±50)μ     

国产与进口西罗莫司洗脱支架置入后血管内超声随访的对比

目的 利用血管内超声对比观察国产与进口西罗莫司洗脱支架对冠心病患者支架术后新生内膜增生的抑制作用.方法 2003年5月至2007年3月,对215例冠心病患者(317处病变)置入西罗莫司洗脱支架,并在术后1年行冠状动脉造影和血管内超声(IVUS)检查.其中Firebird组108例患者(147处病变)置入国产西罗莫司洗脱支架(Firebird支架),Cypher组107例患者(138处病变)置入进121西罗莫司洗脱支架(Cypher支架).结果 两组患者一般临床情况差异无统计学意义.两组靶病变部位、病变长度、狭窄程度及病变类型差异均无统计学意义,但Firebird组术后最小管腔直径大于Cypher组[(2.88±0.43)mm比(2.78±0.33)mm,P＜0.05].随访定量冠状动脉造影分析显示,Firebird组与Cypher组支架内晚期管腔丢失[(0.17±0.29)mm比(0.16±0.27)mm,P＞0.05]和节段内晚期管腔丢失[(0.18±0.36)mm比(0.20±0.32)mm,P＞0.05]差异均无统计学意义.IVUS分析显示,与Cypher组比较,尽管Firebird组支架面积[(6.99±2.25)mm~2比(6.46±1.71)mm~2,P＜0.05]、管腔面积[(6.89±2.30)nm~2比(6.36±1.73)mm~2,P＜0.05]、支架体积[(162.5±68.9)mm~3比(140.8±57.9)mm~3,P＜0.01]、管腔体积[(160.4±69.5)mm~3比(138.6±57.6)mm~3,P＜0.01]及最小支架面积[(5.40±1.85)mm~2比(4.92±1.43)mm~2,P＜0.05]均较大,但两组的内膜增生容积[(2.09±5.46)mm~3比(2.23±6.50)mm~3,P＞0.05]和内膜增生容积百分数[(1.68±5.84)%比(1.59±4.10)%,P＞0.05]差异均无统计学意义.结论 Firebird支架置人后再狭窄的发生率较低,抑制内膜增生作用与Cypher支架相似.     

二尖瓣替换术后人工瓣膜不匹配对肺动脉高压及心房纤颤射频消融治疗效果的影响

目的:研究二尖瓣替换术后人工瓣膜不匹配(Patient-prosthesis mismatch,PPM)的发生情况,及PPM对患者术后肺动脉收缩压及心房纤颤(房颤)射频消融术效果的影响。方法:从2004年10月至2006年10月手术治疗风湿性二尖瓣狭窄或狭窄合并关闭不全的患者29例,其中男性13例,女性16例;年龄30～70岁,平均年龄(53±11.7)岁,均为持续性房颤心律。手术方法为二尖瓣人工瓣膜替换术加Cox-mazeⅢ°房颤射频消融术,使用的人工瓣膜包括机械瓣22例,生物瓣7例。术后计算瓣膜有效开口面积(EOA)和瓣膜有效开口面积指数(IndexedEOA,EOAI),并测定肺动脉收缩压。将EOAI≤1.2cm2/mm2定义为瓣膜不匹配,肺动脉收缩压≥40mmHg(1mmHg=0.133kPa)定义为肺动脉高压。结果:无手术及随访期死亡。随访12～36个月,平均(21.3±7.6)个月。29例患者中17例手术后有效瓣口面积(EOAI)≤1.2cm2/mm2,PPM发生率为58.6%,无PPM(Non-PPM)12例。PPM组与Non-PPM组相比,术后肺动脉收缩压分别下降为(51.4±9.8)mmHg及(35±6.7)mmHg(P0.01);术后持续肺动脉高压的比例分别64.7%(11/17)及33.3%(4/12),P0.01;术后1年房颤复发率分别为35.3%(6/17)及25%(3/12),P0.05;左心房经线分别减少到(50.7±11.2)mm及(42±10.4)mm,P0.05。结论:风湿性二尖瓣替换术后PPM的现象较为常见。二尖瓣位PPM对患者术后持续的肺动脉高压及射频消融术后房颤的复发率有重要影响。