风湿性二尖瓣狭窄伴心房颤动球囊二尖瓣成形术后复…

报道９０例风湿性二尖瓣狭窄伴心房颤动（简称二狭房颤）患者球囊二尖瓣成形术（ＰＢＭＶ）和得律治疗的结果，并与同期行ＰＢＭＶ的１６０例风湿性二尖瓣狭窄无房颤（窦性民主律，简称二狭窦律）患者进行比较。结果表明临床上无血管栓塞并发症且经超声心动图检查无心房血栓的二狭房颤患者接受ＰＢＭＶ治疗与二狭窦律者一样具有良好的安全性和档效果。８９例二狭房颤患者ＰＢＭＶ后经复律治疗转为这生心律（其中１５例仅服用奎尼丁即     

风湿性二尖瓣狭窄伴心房颤动球囊二尖瓣成形术后复律治疗的临床评价

报道９０例风湿性二尖瓣狭窄伴心房颤动（简称二狭房颤）患者球囊二尖瓣成形术（ＰＢＭＶ）和复律治疗的结果，并与同期行ＰＢＭＶ的１６０例风湿性二尖瓣狭窄无房颤（窦性心律，简称二狭窦律）患者进行比较。结果表明临床上无血管栓塞并发症且经超声心动图检查无心房血栓的二狭房颤患者接受ＰＢＭＶ治疗与二狭窦律者一样具有良好的安全性和临床效果。８９例二狭房颤患者ＰＢＭＶ后经复律治疗转为窦性心律（其中１５例仅服用奎尼丁即可复律）。随访２３．５±１１．７月，２４例（２７％）复发。认为房颤持续时间长和左房明显扩大可能是房颤复发的影响因素；ＰＢ－ＭＶ的效果可能是房颤复律后远期疗效的影响因素     

风湿性二尖瓣狭窄伴心房颤动患者球囊二尖瓣成形术疗效及安全性短期评价

风湿性二尖瓣狭窄伴心房颤动患者球囊二尖瓣成形术疗效及安全性短期评价江洪黄从新王晋明许家张庆华陈元秀我们对９０例风湿性二尖瓣狭窄伴心房颤动（房颤）的球囊二尖瓣成形（ＰＢＭＶ）治疗结果并与１６０例风湿性二尖瓣狭窄伴窦性心律（窦律）患者进行比较，以评价二...     

风湿性二尖瓣狭窄伴心房纤颤患者在经皮球囊二尖瓣成形术后的心房纤颤电复律治疗(附538例报告)

探讨风湿性二尖瓣狭窄伴心房纤颤（房颤）球囊二尖瓣成形术（PBMV）后房颤复律治疗的方法及复律后影响维持窦性心律的因素。方法：PBMV术后4～6周仍不能转复为窦性心律的房颤患者538例进行电复律治疗，转复后随诊3～6个月，动态观察房颤复发情况。结果：538例行体表电复律者，恢复窦性心律。     

经皮二尖瓣球囊成形术在二尖瓣狭窄合并房颤中的应用

经皮二尖瓣球囊成形术（PBMV）治疗二尖瓣狭窄的效果已十分肯定。但对于二尖瓣狭窄合并房颤的患者,其治疗效果目前还不是十分明确。目前治疗二尖瓣狭窄合并房颤主要是通过对PBMV的改进以及与一些其他方法的联用。如溶栓治疗的改进、经皮左心耳封闭技术（PLAATO）等一些新技术的发展和治疗房颤技术的改革等。通过PBMV与这些技术相结合,很大地提高二尖瓣狭窄合并房颤的治疗效果。     

二尖瓣球囊扩张术中心包填塞4例的处理

经皮二尖瓣球囊扩张术(PBMV)是治疗风湿性二尖瓣狭窄的一项安全、有效的治疗方法,但PBMV过程中有可能出现各种并发症,尤以急性心包填塞最为凶险。本文将PBMV术中出现的4例急性心包填塞报告于下。1对象与方法4例风湿性心脏病患者均为女性,年龄为46～56岁。2例为单纯重度二尖瓣狭     

二尖瓣狭窄并发房颤行球囊成形术前抗凝与不抗凝的比较

目的 :评价二尖瓣狭窄并发房颤患者行经皮二尖瓣球囊成形术 （PBMV）前是否需要常规抗凝治疗。方法 :风湿性心脏病二尖瓣狭窄并发房颤患者 2 5 1例 ,按就诊先后随机分为 A（n=12 6 ） ,B（n=12 5 ）两组。控制心力衰竭后行PBMV。A组术前不使用任何抗凝药物及抗血小板药物 ,B组术前常规给予肝素、肠溶阿斯匹林及华法令抗凝 ,观察PBMV术中及术后 3d有无与 PBMV相关的体循环栓塞并发症。结果 :两组患者 PBMV均获成功 ,术中及术后均无栓塞并发症发生 ,术后血流动力学指标、心功能、二尖瓣口面积、心脏杂音均有明显改善 （P<0 .0 1）。结论 :二尖瓣狭窄并发房颤患者如既往无体循环栓塞史 ,左心房无附壁血栓 ,行 PBMV前并不需苛求常规抗凝。     

二尖瓣狭窄球囊成形术后心房颤动的复律治疗及其影响因素

为评价二尖瓣球囊成形术（ＰＢＭＶ）后心房颤动的复律疗效及维持窦性心律的影响因素，对３０例风湿性心脏病二尖瓣狭窄伴心房颤动（简称二狭房颤）的患者在ＰＢＭＶ后１～２周进行复律治疗。结果显示：ＰＢＭＶ后近期复律治疗房颤均能转复为窦性心律。随访１９～４６（３１．６±７．１）月，２２例患者仍维持窦性心律（７３．３％）。房颤复发与患者的年龄、二狭程度无明显关系。房颤病程超过１２个月，ＰＢＭＶ后左房残留压较高和术后左房回缩程度小是房颤复发的重要影响因素。     

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...     

老年风湿性二尖瓣中重度狭窄合并主动脉瓣轻中度关闭不全患者行经皮二尖瓣球囊扩张术的疗效

<正>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,使其成为风湿性二尖瓣狭窄的首选治疗方法。在临床中发现老年风湿性二尖瓣狭窄多合并有主动脉瓣关闭不全,外科手术由于创伤高龄等因素多不被患者及其家属接受,因此,PBMV对此类患者显得较为重要。本研究旨在观察老年风湿性二尖瓣狭窄合并主动脉瓣关闭不全患者进行PBMV的疗效。1资料与方法1.1受试对象我院住院的风湿性二尖瓣中重度狭窄合并主     

风心病二尖瓣狭窄合并窦性心律患者经皮球囊二尖瓣成形术后即刻P波离散度变化与左房平均压变化之间的关系

目的探讨风心病二尖瓣狭窄合并窦性心律患者经皮球囊二尖瓣成形术(PBMV)后即刻P波离散度(Pd)变化与左心房(左房)平均压(LMAP)变化之间的关系。方法选取成功进行PBMV风心病二尖瓣狭窄合并窦性心律患者32例,测量PBMV术前、术后即刻Pd、LMAP、二尖瓣口面积(MVA)及左房大小(LAS),计算Pd变化值,并与LMAP、MVA和LAS变化值行相关性分析。结果PBMV术后即刻Pd与LMAP明显减小(P<0.05)、MVA明显增加(P<0.05)、LAS无明显变化(P>0.05);Pd变化值仅与LMAP变化值之间具有相关性。结论风心病二尖瓣狭窄合并窦性心律患者PBMV术后即刻Pd变化与LMAP变化可能有关,提示心房牵张可能是引起风心病二尖瓣狭窄合并窦性心律患者Pd变化的原因。     

二尖瓣球囊扩张术对患者血浆B型利钠肽水平的影响

目的:观察二尖瓣球囊扩张术(PBMV)对二尖瓣狭窄患者血浆B型利钠肽(BNP)水平的影响。方法:检测30例成功施行PBMV的二尖瓣狭窄患者(窦性心律21例,心房颤动9例)术前、术后20 min及术后24 h的血浆BNP浓度,与8例对照者比较,并将BNP浓度与血流动力学参数作相关分析。结果:术前30例二尖瓣狭窄患者血浆BNP水平显著高于对照者(P<0．01);且与平均左心房压(r=0．441,P< 0．05)和肺动脉压(r=0．488,P<0．01)呈正相关。心房颤动患者与窦性心律患者BNP浓度无明显差异。术后20 mim及术后24 h窦性心律患者BNP浓度较术前显著下降(P均<0．05),术后24 h左心室舒张末容量(P<0．01)和每搏输出量(P<0．05)较术前相应增加,左心室舒张末压不变;术后20 min的BNP浓度变化与平均左心房压变化(r=0．696,P <0．01)及肺动脉压变化(r=0．456,P<0．05)呈正相关。术后心房颤动患者BNP浓度较术前无明显改变,左心室舒张末容量和每搏输出量相应不变,左心室舒张末压术后20 min较术前增加(P<0．01)。结论:二尖瓣狭窄患者血浆BNP浓度升高和左心房压及肺动脉压升高相关。心脏节律对球囊扩张术后血浆BNP的变化起重要作用,BNP是反映窦性心律患者球囊扩张术后左心房压及肺动脉压变化的敏感指标,但这一指标不适用于心房颤动患者。     

Neurohormones in mitral stenosis before and after percutaneous balloon mitral valvotomy

BACKGROUND AND AIM OF THE STUDY: The hormonal response to percutaneous balloon mitral valvotomy (PBMV) has been described in patients in sinus rhythm (SR) and with atrial fibrillation (AF). The study aim was to evaluate the effect of hemodynamic parameters and PBMV on atrial natriuretic factor (ANF) secretion and plasma renin activity (PRA) in mitral stenosis in SR and AF. METHODS: Thirty-one patients (26 females, five males; mean age 50.5+/-14 years) with pure rheumatic mitral stenosis underwent PBMV. Fourteen patients had AF, and 17 were in SR. PRA and ANF were measured 24 h before, and at 30 and 60 min, 24 h and one month after PBMV, after resting in a supine position for > or =2 h. Digitalis and diuretics were withdrawn 48 h before sampling; neither had patients received ACE inhibitors or beta-blockers during the previous month. RESULTS: PBMV was successful in all cases, without complication. Mitral valve area was increased and wedge pressure decreased in both groups after PBMV. In AF patients, neither PRA nor ANF were significantly affected before and after PBMV; in SR patients, ANF was decreased and PRA increased significantly, notably 24 h after PBMV. The cardiac index was increased in both groups, but was distinctly lower in AF patients both before and after PBMV. CONCLUSION: Despite similar hemodynamic results, reversal of the hormonal pattern after PBMV occurred only in SR patients, most likely because in AF patients a low cardiac index elicits a hormonal response similar to heart failure. This abnormal hormonal pattern may limit functional recovery after PBMV; hence, PBMV is best attempted while patients are still in SR.     

One-year outcome of cardioversion of atrial fibrillation in patients with mitral stenosis after percutaneous balloon mitral valvuloplasty

Our objectives were to study the success rate of electrical cardioversion after percutaneous balloon mitral valvuloplasty (PBMV) in patients with symptomatic moderate-to-severe mitral stenosis and atrial fibrillation (AF) and the maintenance rate of sinus rhythm for < or =1 year. We studied patients with mitral stenosis and AF who were scheduled for PBMV. Electrical cardioversion was performed 1 month after PBMV. Amiodarone 200 mg/day was started the day after PBMV. The primary outcomes studied were the rate of successful cardioversion and the maintenance rate of sinus rhythm at 12 months. Of 272 patients scheduled for PBMV, 70 were enrolled. The average age was 45 +/- 10 years. The average mitral valve area was 0.82 +/- 0.22 cm(2). Cardioversion was successful in 50 patients (71%). Logistic regression analysis revealed that left atrial size and associated aortic valvular disease were predictors of successful cardioversion. Of the 50 patients with successful cardioversion, AF recurred in 24 (48%). An increased left atrial diameter was the only factor associated with AF recurrence at 12 months. In conclusion, good candidates for cardioversion after PBMV were those with a left atrial diameter of <60 mm and no associated aortic valvular disease -- approximately 43% of patients with AF scheduled for PBMV. In this group, about 2/3 were in sinus rhythm at 12 months after cardioversion.     

Effect of percutaneous transvenous mitral commissurotomy for the preservation of sinus rhythm in patients with mitral stenosis

OBJECTIVES: Atrial fibrillation is frequently associated with mitral stenosis and is considered to be an unfavorable factor for the long-term prognosis. The efficacy of percutaneous transvenous mitral commissurotomy(PTMC) was examined for the preservation of sinus rhythm in patients with mitral stenosis after PTMC. METHODS: Long-term clinical data after PTMC were obtained from 71 patients who had undergone PTMC from March 1989 to September 1999. Eighteen patients in sinus rhythm before PTMC were divided into two groups: the SR group(n = 5) who remained in sinus rhythm, and the Af group(n = 13) who showed change from sinus rhythm to persistent or paroxysmal atrial fibrillation after PTMC. RESULTS: Age, sex, mitral valve area(1.4 +/- 0.3 vs 1.2 +/- 0.3 cm2), mean mitral pressure gradient(14.3 +/- 5.5 vs 12.6 +/- 5.9 mmHg), mean left atrial pressure(15.9 +/- 7.6 vs 19.0 +/- 7.7 mmHg), left ventricular end-diastolic pressure(7.5 +/- 2.8 vs 9.3 +/- 3.9 mmHg), left ventricular end-diastolic volume index(77 +/- 13 vs 82 +/- 14 ml/m2), left ventricular ejection fraction(60 +/- 6% vs 55 +/- 4%) and cardiac output(5.1 +/- 0.4 vs 4.9 +/- 0.8 l/m2) before PTMC were not different between the two groups. Changes in mean mitral pressure gradient, mean left atrial pressure and cardiac output immediately after PTMC were not different statistically. Mitral valve area immediately after PTMC was significantly greater in the SR group compared to the Af group(2.3 +/- 0.3 vs 1.8 +/- 0.3 cm2, p < 0.05). The change in mitral valve area was also greater in the SR group(1.0 +/- 0.2 vs 0.6 +/- 0.4 cm2, p < 0.05), but there was no statistical difference in the percentage change of mitral valve area between before and immediately after PTMC(SR group 78 +/- 35% vs Af group 50 +/- 35%). End-diastolic pressure, end-diastolic volume index and ejection fraction immediately after PTMC were not statistically different. CONCLUSIONS: The final mitral valve area immediately after PTMC in the patients with mitral stenosis in sinus rhythm, but not the changes of mean mitral pressure gradient, mean left atrial pressure or cardiac output, is important for the maintenance of sinus rhythm.     

分级次二尖瓣球囊扩张术治疗重度二尖瓣狭窄伴心房颤动的临床研究

为评价分级扩张法行经皮穿刺二尖球囊扩张术（PBMV）的临床疗效。采用分级次扩张法对52例风湿性二尖瓣狭窄（MS）患者进行,分重度MS伴心房颤动（AF）组和中，重度MS无AF组。根据身高2确定首次扩张直径，每次递量0.5-1mm，直至疗效满意。术前，术后进行二维超声和多普勒，血流动力学检查。结果显示，52例PBMV均获成功，术后血流动力学明显改善，心功能明显提高，无重要并发症发生，两组间比较无明显差异。提示分级次扩张法可有效预防二尖瓣反流，低心排，急性左心衰，栓塞等并发症，并获得良好效果，尤其对重度MS伴AE者，不失为一种理想的治疗方法。     

风湿性二尖瓣狭窄伴左室偏小患者球囊扩张术后的近期临床观察

目的　观察风湿性二尖瓣狭窄伴左室偏小患者经皮二尖瓣球囊扩张术 (PBMV)的球囊直径及扩张后心功能 ,血流动力学及心腔大小的变化。方法　选择风湿性二尖瓣狭窄伴左室偏小患者共 2 7例 ,采用Inoue法行PBMV ,球囊扩张直径为身高 / 10 +10mm ,分别测定其扩张前后左房及左室压力 ;随访其术前及术后近期心功能 ;超声评价术前 1周、术后 1周、1、3、6月二尖瓣瓣口面积、二尖瓣跨瓣压差、最大肺动脉收缩压及心腔大小的变化。结果　扩张即刻左房压力及二尖瓣跨瓣压差明显下降 ,舒张期杂音减轻 ,左室舒张末期压力增加 ;术后一周左房内径变小 ,左室内径增大 ,心功能改善不明显 ;术后一月左房内径变小 ,左室内径增大及心功能改善均达最佳效果 ,并维持至观察结束时。结论　风湿性二尖瓣狭窄伴左室偏小患者仍可以球囊直径 =身高 / 10 +10mm进行扩张 ;术后 1周心腔大小明显变化 ,1月达最佳效果 ;心功能的改善 1月才达最佳效果。     

P波离散度对经皮球囊二尖瓣扩张术后心房纤颤发作的预测价值

目的 探讨P波离散度预测经皮球囊二尖瓣扩张术(PBMV)后心房纤颤发作的价值.方法 选择风湿性心脏病,二尖瓣狭窄并成功行PBMV术,术前为窦性心律者,共95例.所有患者均测量PBMV前12导联同步心电图P波宽度,计算最宽P波(Pmax)、最窄P波(Pmin)并取两者差的平均值,即为P波离散度(Pd),Pd=Pmax-Pmin.结果PBMV术后59例患者维持窦性心律(对照组),男8例,女51例,年龄24～57岁(36.8±8.3岁);36例患者出现心房纤颤(房颤组).男13例,女23例,年龄18～56岁(38.1±7.8岁).两组患者在年龄、心率、左室舒张期内径、右室舒张期内径和左室射血分数无统计学差异.房颤组左房内径(46.63±2.36mm)比对照组(43.51±2.51mm)显著增大(P<0.05).房颤组Pmax(121.67±14.64ms)、Pd(37.50±9.37ms)比对照组Pmax(106.38±12.24ms)、Pd(23.97±12.70ms)显著延长(P<0.01).以Pmax≥110ms预测心房纤颤的敏感性80.55%,特异性50.85%,准确性61.05%.以Pd≥40ms预测心房纤颤的敏感性69.44%,特异性32.20%,准确性68.42%.结论 Pd作为一项无创性心电学指标,对PBMV术后发作心房纤颤的预测有一定临床价值.