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     

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。     

风湿性二尖瓣狭窄伴心房纤颤球囊二尖瓣成形术后心房纤颤的复律治疗

报道９０例风湿性二尖瓣狭窄伴心房纤颤（简称二狭房颤）球囊二尖瓣成形术（ＰＢＭＶ）后复律治疗的结果。８９例患者在ＰＢＭＶ后２周内接受复律治疗，１５例服用奎尼丁后恢复窦性心律，７４例经体表电复律转为窦性心律。随访２３．５±１１．７个月，２４例（２７％）患者心房纤颤复发。我们认为心房纤颤病程长，ＰＢＭＶ后瓣口面积小和左房回缩差是心房纤颤复发的可能原因。     

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球囊二尖瓣成形术后心房纤颤的…

报道９０例风湿性二尖瓣狭窄伴心房纤颤球囊二尖瓣成形术后复律治疗的结果。８９例患者在ＰＢＭＶ后２周内接受复律治疗，１５例服用奎尼丁后恢复窦性心律，７４例经体表电复律转为窦性心律。     

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。     

风湿性二尖瓣狭窄球囊成形术的临床应用

为了观察经皮球囊成形术（ＰＢＭＶ）对风湿性二尖瓣狭窄的临床疗效，对２９３例风湿性二尖瓣狭窄病人进行ＰＢＭＶ治疗。结果表明：（１）ＰＢＭＶ的成功率为９９％，术后即刻血流明显动力学明显改善，其中５２例外科术后再狭窄和４５例并存二尖瓣、主动脉瓣关闭不全的患者也获得了与原发性狭窄和单纯性狭窄相似的临床效果。（２）１０５例病人并发心房纤颤，１０３例ＰＢＭＶ成功，无１例发生栓塞并发症，术后１０２例接受复律治疗     

风湿性二尖瓣狭窄伴心房颤动二尖瓣球囊扩张术疗效评价

对26例风湿性二尖瓣狭窄伴心房纤额（房颤二狭）与同期31例风湿性二尖瓣狭窄无房颤（窦律二狭）患者PBMV术后及随访结果进行比较，结果显示：虽然房颤二狭具有血栓发生率高、左房前后径大、瓣膜超声评分高等特殊性，但只要术前抗凝准备充分，操作仔细，房颤二狭接受PBMV治疗与窦律二狭一样具有良好的安全性和临床效果。     

经皮二尖瓣球囊成形术和血栓前状态

目的：探讨经皮二尖瓣球囊成形术（ＰＢＭＶ）前后血栓前状态与血液动力学的变化。　　方法：对２０ 例有症状的风湿性心脏病二尖瓣狭窄患者根据其心律情况分为窦性心律组（ｎ＝ ８）,和心房颤动心律组（ｎ＝ １２）,并施行ＰＢＭＶ,观察ＰＢＭＶ前后血液流变学和血液动力学参数。同时选择２０名正常人作为正常对照（正常对照组）。　　结果：在ＰＢＭＶ后血液动力学参数发生变化的同时纤维蛋白原（Ｆｂｇ）显著下降（Ｐ＜ ０．０１）。左心房血液成份在心房颤动心律组与窦性心律组之间有明显差异（Ｐ＜ ０．０５～０．０１）,其中Ｄ－二聚体和全血粘度的低切变差异最显著（Ｐ＜０．０１）。　　结论：风湿性心脏病二尖瓣狭窄患者存在血栓前状态基础和血液动力学异常,尤其是心房颤动者,应常规使用抗凝药     

外科二尖瓣交界分离术后再狭窄二尖瓣球囊成形术

将６６例二尖瓣狭窄患者首次行ＰＢＭＶ和１８例外科分离术后再狭窄患者行ＰＢＭＶ进行比较，结果表明两者扩瓣治疗前、后的血流动力学指数有明显差异（Ｐ＜０．００１），但将两者术后相应的血流动力学指数进行比较差异无显著性（Ｐ＞０．０５）。说明外科二狭分离术后再狭窄患者成功地进行ＰＢＭＶ可显著改善临床症状，仍是一种有效的方法。     

经皮球囊二尖瓣成形术后心房颤动复律患者血浆中利钠肽和脑钠肽的变化

目的:观察经皮球囊二尖瓣成形术(PBMV)后心房颤动(房颤)成功复律与未复律患者血浆中心房利钠肽(ANP)和脑钠肽(BNP)的变化,并探讨与血流动力学参数的关系.方法:选择成功PBMV的风湿性二尖瓣狭窄伴持续房颤律患者48例,其中成功复律组20例,未复律28例,获得外周静脉血及血流动力学完整资料.分别用放射免疫法和酶链免疫法测定血浆中ANP、BNP值,由超声心动图测左房内径(LAD)、二尖瓣口面积(MVA)、二尖瓣跨瓣压差(MPG)、左室舒张末径(LVEED).结果:随访至PBMV后1年,复律组患者血浆中ANP和BNP逐步下降,而未复律组BNP呈下降趋势,但差异无统计学意义(P>0.05), 复律组LAD和MPG较未复律组显著缩小(P<0.05).ANP、BNP与血流动力学指标之间相关性比较显示:复律组,术后1年与术前比较△LAD与△ANP下降仍呈正相关性(r=0.774;P<0.05),而△BNP与△MPG有相关(r=0.574;P<0.05).结论:PBMV后,房颤复律可进一步改善血流动力学,缩小LAD,降低血浆中ANP和BNP水平,复律后ANP和BNP的变化,仍是间接反映LAD和MPG变化趋势的有效指标.     

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.     

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。     

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。     

Atrial fibrillation: how effectively can sinus rhythm be restored and maintained after balloon mitral valvotomy?

Atrial fibrillation, commonly associated with rheumatic mitral stenosis, worsens the prognosis. We studied the efficacy of achieving and maintaining sinus rhythm in patients with chronic atrial fibrillation who underwent a successful balloon mitral valvotomy. Fifty-four patients (26 men, 28 women; age 36+/-8 years) received amiodarone 200 mg thrice daily in the first week, and thereafter a maintenance dose of 200 mg once daily. Electrical cardioversion was attempted at 1 and 3 months and patients were followed up at 6, 12 and 18 months. At the end of 1, 3, 6, 12 and 18 months 81 percent, 72 percent, 60 percent, 54 percent and 49 percent of patients, respectively, were in sinus rhythm. Only one patient had a severe adverse effect (hypothyroidism). Univariate analysis revealed that lower age, shorter duration of atrial fibrillation and smaller left atrial size was associated with successful restoration to sinus rhythm. On multivariate analysis, the duration of atrial fibrillation was the only significant predictor of long-term maintenance of sinus rhythm. Amiodarone seems safe and reasonably effective in restoration and maintenance of sinus rhythm in patients of atrial fibrillation with rheumatic heart disease.     

Evaluation of left ventricular long-axis function in cases of rheumatic pure mitral stenosis with atrial fibrillation

Using tissue Doppler echocardiography, we evaluated left ventricular long-axis function in 65 mitral stenosis patients, 30 of whom were in sinus rhythm and 35 of whom were in chronic atrial fibrillation. There were 35 healthy control subjects. Conventional echocardiography was used to evaluate left ventricular diameters, left atrial diameters, left ventricular ejection fractions, and mitral valve areas. Tissue Doppler echocardiography was used to evaluate isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), ejection time (ET), and peak systolic myocardial velocities. The myocardial performance index was calculated with the formula (ICT+IRT)/ET. Mean and segmental left ventricular IRT and ICT values were significantly longer in mitral stenosis patients than in control subjects, but were similar in the sinus rhythm and atrial fibrillation subgroups. Ejection times were significantly lower in the mitral stenosis with atrial fibrillation group than in the mitral stenosis with sinus rhythm and control groups (P<0.001), but were similar when the sinus rhythm group was compared with the control group (P<0.05). Myocardial performance index values were higher in mitral stenosis patients, significantly so in those with atrial fibrillation when compared with the control group (P<0.001). Systolic velocity values were significantly lower in mitral stenosis patients, more markedly so in those with atrial fibrillation than in the control group (P<0.001).We conclude that patients with pure rheumatic mitral stenosis, most particularly when in combination with atrial fibrillation, have significantly impaired left ventricular long-axis function as evaluated by tissue Doppler echocardiography, although global systolic function may be normal.     

High Sensitivity CRP Levels Predict Atrial Tachyarrhythmias in Rheumatic Mitral Stenosis

Background: The different levels of inflammation in rheumatic mitral stenosis determine its clinical consequences. Atrial fibrillation is frequently encountered in mitral stenosis, though the independent role of chronic inflammation in determining atrial tachyarrhythmia occurrence in rheumatic heart disease has not been demonstrated previously. Methods: Measurements of C‐reactive protein (CRP) with a high sensitivity assay to detect chronic inflammation were performed in a homogenous group of 50 patients with rheumatic mitral stenosis, who were in sinus rhythm. Patients were questioned to exclude confounders of CRP elevation. The patients underwent a twenty‐four‐hour ambulatory ECG monitoring to check for asymptomatic atrial tachyarrhythmias and were in addition classified according to the presence of atrial tachyarrhythmias. Results: Forty‐four percent of patients showed a total of 100 episodes of atrial tachyarrhythmias where 63% of these episodes were paroxysmal atrial fibrillation. The CRP values in patients with tachyarrhythmias were significantly higher than in patients who remained in sinus rhythm (4.2 ± 0.55 mg/L vs 1.99 ± 0.36 mg/L, P < 0.001). A logistic regression analysis revealed only CRP levels and previous history of mitral valvuloplasty significantly determined tachyarrhythmia occurrence where age, left atrial volumes, mitral gradients had no statistically significant effect. Conclusions: Our data implicated that nearly half of the mitral stenosis patients who are in sinus rhythm develop asymptomatic tachyarrhythmias and the higher levels of CRP in these patients show the significant effect of persistent inflammation on arrhythmia occurrence.     

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.