球囊直径递增法在经皮球囊二尖瓣成形术中的应用

我院自1993年2月份开始对29例风湿性心脏瓣膜病二尖瓣狭窄患者采用球囊直径递增法进行经皮球囊二尖瓣成形术,取得满意效果,现报告如下。 1 对象与方法 1.1 病例选择:29例患者均符合以下条件:单纯二尖瓣狭窄或伴有轻度关闭不全;二尖瓣口面积小于1.5cm~2;无心房血栓证据或体循环栓塞史;无风湿活动证据;瓣膜无严重钙化。29例中男11例,女18例,年龄24～73岁。病程4月～28年,平均7.6年。单纯二尖瓣狭窄24例,伴轻度关闭不全5例。 1.2 方法:采用改良的Inoue方法。根据患者     

4例经皮球囊二尖瓣成形术致心包填塞的护理

经皮穿刺球囊二失瓣成形术自1985年引进我国以来,由于不需开胸,创伤小,安全系数大,成功率高而得到广泛推广,目前已成为治疗二尖瓣狭窄的一种比较成熟的介入治疗方法。但该手术偶可发生心包填塞,若抢救不及时,可危及病人生命。我院1995年10月～1997年6月发生4例心包填塞,现将我们的抢救护理体会介绍如下。1临床资料4例患者均为女性,年龄32～43岁,确诊风心病。二尖瓣狭窄。其中1例会并主动脉瓣轻度关闭不全,心功11～ffi级：1例会并肺部感染、心力衰竭,心功Ⅳ级,经抗感染及抗心衰治疗后,病情稳定,接受手术;另外2例为择期手术病…     

二尖瓣狭窄并发左房血栓抗凝溶栓后二尖瓣球囊成形术

风心病二尖瓣狭窄（MS）并发左房血栓是二尖瓣球囊成形术（PBMV）的禁忌症,常需外科手术治疗[1]。我们对20例瓣膜条件较好而又合并左房血栓的MS患者口服华法令抗凝溶栓治疗后,成功施行了PBMV,报道如下。1资料与方法1．1一般资料20例MS并发左房血栓患者中,男8例,女12例;平均年龄38（29～50）岁。风心病史5～16年,均合并心房纤颤1月～2年。心功Ⅱ、Ⅲ级。单纯MS14例,合并轻度二尖瓣关闭不全3例,轻度主动脉瓣关闭不全2例,同时合并轻度二尖瓣关闭不全和轻度主动脉瓣关闭不全1例。心脏超声和心电图均未显示左心室负荷过重。1.2…     

512例经皮球囊二尖瓣成形术适应症探讨

应用经皮球囊二尖瓣成形术治疗５１２例二尖瓣狭窄患者，并共适应证进行了讨论。认为：随着技术水平的提高，球囊导管的改进，基础疗效的肯定上皮性其适应症范围可在临床扩大，其并发症可进一步降低。     

经食管超声心动图在二尖瓣球囊成形术中的应用

经食管超声心动图在二尖瓣球囊成形术中的应用王素梅，田家玮，孙艳，李宝杰，关振中，范福英，宋佳敏１资料与方法本文２０例均为我院风心病以二尖瓣狭窄为主的行ＰＢＭＶ术前病人，男８例，女１２例，年龄３５～５１岁，平均４０岁。２０例患者均经胸做了超声心动图检查...     

风心病二尖瓣狭窄伴左房血栓患者经皮球囊二尖瓣成形术

经皮球囊二尖瓣成形术 (ｐｅｒｃｕｔａｎｅｏｕｓｂａｌｌｏｎｍｉｔｒａｌｖａｌｖｕｌｏｐｌａｓｔｙ ,ＰＢＭＶ)为治疗风湿性心脏病 (风心病 )二尖瓣狭窄 (ｍｉｔｒａｌｓｔｅｎｏｓｉｓ,ＭＳ)有效的介入方法 ,但左房血栓存在常列为ＰＢＭＶ的禁忌证 ,风心病ＭＳ心房颤动又往往伴有左房血栓。近几年来 ,我们对伴有左房血栓的风心病ＭＳ患者行ＰＢＭＶ ,既安全又获得显著疗效 ,现报道如下。1　资料与方法1.1　临床资料　从 1992年 10月至 2 0 0 1年 9月进行ＰＢＭＶ1310例 ,其中风心病ＭＳ伴有左房血栓 2 5例 ,男 9例 ,女 16例 ,年龄 2 2…     

经食道超声心动图在二尖瓣球囊成形术中的应用现状

经皮穿刺二尖瓣球囊成形术(PBMV)是治疗风湿性心脏病二尖瓣狭窄的非开胸手术治疗法。近几年来经食道超声心动图(TEE)技术不断完善并在临床上广泛应用。在显示左房、房室瓣、上腔静脉、肺静脉、升主动脉、降主动脉等结构时具有经胸壁超声心动图(TTE)所不可比拟的优越性,故最近国外有不少学者把TEE技术用于监视PBMV全过程,使     

改良的房间隔穿刺法在经皮球囊二尖瓣成形术中的临床应用

目的：评价改良的房间隔穿刺法在经皮球囊二尖瓣成形术（PBMV）中的应用价值。方法：风湿性心脏病二尖瓣狭窄患者95例,按住院先后顺序分为A、B两组行PBMV。A组27例,房间隔穿刺采用左房影定位法：B组68例,采用改良的房间隔穿刺法,其余操作方法两组均相同。比较两组的成功率、并发症以及手术时间,并观察术前、后两组间左房压力（LAP）、二尖瓣跨瓣压差（MPG）及二尖瓣口面积（MVA）有无差别。结果：两组术后LAP、MPG均较术前明显降低,MVA较术前明显增加;术后LAP、MPG、MVA两组间比较无明显差别,但B组成功率明显高于A组,并发症发生率显著降低,手术时间及X线曝光时间也明显缩短。结论：改良的房间隔穿刺法安全、可靠、成功率高,且可显著降低并发症、缩短手术时间及X线曝光时间,值得临床推广应用。     

超声心动图在二尖瓣球囊成形术中的应用

超声心动图(UCG)越来越受到了临床的重视与信赖.已经成为不可缺少的甚至是唯一有效的诊查手段。在发展的介入性治疗之一,经皮二尖瓣球囊成形术(PTMC)中也同样显示了UCG的重要价值。我院从1990年10月至1992年6月应用PTMC治疗风湿性二尖瓣狭窄118例,手术前后所有病人均经过UCG捡查,其中78例(占66％)UCG在手术中进行跟踪监测,均获成     

Transesophageal echocardiography during percutaneous balloon mitral valvuloplasty

To ascertain the value of transesophageal echocardiography during percutaneous balloon mitral valvuloplasty, the present study was undertaken in 26 anesthesized patients (21 women and 5 men; mean age, 47 years) with symptomatic rheumatic mitral valve stenosis. In all but one patient the balloon dilation of the mitral valve was successful and Doppler-derived valve area increased (0.9 +/- 0.3 to 1.9 +/- 0.4 cm2). Transesophageal echocardiography provides continuous monitoring, as well as guidance of the procedure. Crossing the arterial septum, as well as delivery of the sheath through the mitral valve orifice and correct positioning of the balloon, was highly facilitated and reduced x-ray exposure time. The degree of mitral regurgitation and the presence of interatrial shunting at the end of the procedure could be readily assessed, making cineangiography not necessary. Complications of the procedure, such as pericardial effusion, could be detected before hemodynamic deterioration had occurred (one patient). The advantages of transesophageal echocardiography for routine monitoring of percutaneous mitral valvuloplasty, however, should be weighted against the added risk and expense of this support.     

Efficacy of percutaneous mitral balloon valvuloplasty with the inoue balloon

Percutaneous mitral balloon valvuloplasty has become an accepted technique for use in selected patients with severe, symptomatic mitral stenosis. Recently, a new balloon catheter with an "hourglass" shape and specially designed guidewires and dilators has become available (Inoue balloon). The design of this balloon provides ease of manipulation and self-stabilization across the mitral valve during inflation. These features should decrease the incidence of complications associated with the procedure. Preliminary results in 12 consecutive patients who underwent percutaneous mitral balloon valvuloplasty with the Inoue balloon are presented. The mitral valve area increased from 0.92 +/- 0.21 cm2 before the procedure to 1.75 +/- 0.40 cm2 after the procedure. No complications occurred from the procedure, including no increase in severity of mitral regurgitation or creation of an atrial septal defect. Further follow-up is necessary to determine the long-term efficacy with this new balloon. Nonetheless, the preliminary results are encouraging.     

经皮二尖瓣球囊扩张术治疗风湿性二尖瓣狭窄患者长期疗效

目的　评价经皮二尖瓣球囊扩张术 (PBMV)后远期疗效。方法　对 10 7例患者接受PBMV术治疗后进行随访 ,包括超声心动图和临床心功能评价 ,平均随访时间 (5 .3± 1.6 )年。结果　超声心动图的术前、术后 7天内、随诊的二尖瓣面积、左房内径、二尖瓣跨瓣压力阶差分别为 (1.0 4± 0 .2 1)mm2 、(4 6± 6 )mm、(18± 7)mmHg(1mmHg=0 .133kPa) ;(1.73± 0 .2 7)mm2 、(4 4± 8)mm、(8± 4 )mmHg ;(1.6 3± 0 .2 4 )mm2 、(38± 6 )mm、(10± 4 )mmHg。术前与术后 7天内相比P <0 .0 1,术前与随访相比P <0 .0 1,再狭窄率为 10 % ,心功能改善并维持Ⅰ、Ⅱ级有 86 .9%(93例 )。结论　PBMV治疗风心病二尖瓣狭窄的远期效果良好 ,未见严重并发症。     

合并左心房血栓患者的经皮球囊二尖瓣成形术的临床评价

目的评价经皮二尖瓣球囊成形术(PBMV)治疗风湿性心脏病二尖瓣狭窄合并左心房血栓的可行性、安全性和有效性。方法应用华法林抗凝治疗3个月以上的风湿性心脏病二尖瓣狭窄合并左心房血栓患者28例,术前1周再应用小剂量尿激酶溶栓治疗5天,采用改良的Inoue单球囊技术行PBMV。观察PBMV术后血流动力学与超声心动图指标改变,术后随访半年,观察术中及随访期间有无体循环血栓栓塞并发症。结果手术成功率为100%。左心房平均压(LAPm)和跨二尖瓣压力阶差(MVPG)分别由术前的(24.3±4.2)mm Hg(1 mm Hg=0.133kPa)和(17.6±4.9)mm Hg下降至术后的(11.3±4.5)mm Hg(P<0.05)和(7.2±3.9)mm Hg(P<0.05),左心房内径(LAD)由术前(58.2±5.6)mm减小到术后24小时(48.5±5.8)mm(P<0.05)和术后6个月(44.5±5.8)mm(P<0.05),二尖瓣口面积(MVA)由术前(0.80±0.36)cm2增大至术后24小时(1.88±0.34)cm2(P<0.01)和术后6个月(1.76±0.27)cm2(P<0.01),肺动脉压力(PP)由术前的(72.8±15.6)mm Hg下降至术后24小时(43.2±13.2)mm Hg(P<0.01)和术后6个月(39.5±13.6)mm Hg(P<0.05)。术中及随访期间无1例患者发生血栓栓塞并发症。结论对于合并左心房血栓患者经较充分的华法林抗凝治疗,PBMV是安全可行且疗效满意的。     

经皮二尖瓣球囊扩张术治疗风湿性二尖瓣狭窄的随访观察

目的:观察经皮二尖瓣球囊扩张术(PBMV)治疗风湿性二尖瓣狭窄的中远期疗效。方法:采用Inoue单球囊对150例风湿性二尖瓣狭窄患者行PBMV治疗,并进行了长期随访,随访时间12～96(46±22)月。结果:二尖瓣瓣口面积由0.98±0.16cm~2增至1.86±0.54cm~2,二尖瓣平均跨瓣压差由19.6±7.2mmHg降至10.3±5.6mmHg,10例出现明显再狭窄,其中6例再次行PB-MV术,4例行瓣膜置换术。结论:PBMV治疗风湿性二尖瓣狭窄的中远期效果良好,瓣下病变的严重程度将影响中远期疗效。     

多普勒超声心动图引导二尖瓣狭窄球囊扩张的研究

目的探讨经胸多普勒超声心动图在引导二尖瓣狭窄球囊扩张术中的作用.方法以彩色、连续波及脉冲波多普勒技术引导球囊扩张术中逐渐递增球囊直径,结合二维超声心动图及X线,共同对35例二尖瓣狭窄患者施行经皮穿刺二尖瓣球囊扩张术.结果所有患者均取得满意扩张效果,无一例出现重度二尖瓣反流.二尖瓣跨瓣流速由(2.47±0.46)m/s降至(1.68±0.37)m/s(P＜0.001),跨瓣压差由(25.10±9.60)mm Hg降至(12.27±4.72)mm Hg(P＜0.001),瓣口面积从(1.28±0.23)cm2扩大至(2.23±0.31)cm2(P＜0.001).结论应用多普勒超声心动图引导二尖瓣狭窄的球囊扩张既可达到充分扩张狭窄二尖瓣的目的,又可最大限度地避免和减少二尖瓣关闭不全的发生,较单纯X线引导的方法更为优越.     

Coronary flow reserve in mitral stenosis before and after percutaneous balloon mitral valvuloplasty

We aimed to evaluate the coronary flow reserve (CFR) before and after percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral stenosis (MS) and its association to clinical events. A prospective study included 45 patients with mitral stenosis candidate for PBMV (age 38?±?19 years, 27 were females) and 20 with matched age and sex, healthy controls were included in the study. Noninvasive CFR was measured using transthoracic echocardiography and utilizing adenosine stress echocardiography (0.14 mg/kg/min) before PMBV, and one weak post PBMV using multi-tract balloon valvuloplasty technique. CFR was significantly lower in patients with MS compared to controls (P?<?0.001). Moreover the CFR was significantly increased post-PBMV (P?<?0.001) associated with significant increase in LVEF% (P?<?0.05), decrease in systolic pulmonary artery pressure (P?<?0.001), significant increase in TAPSE (P?<?0.001). CFR was significantly correlated with the degree of change (Δ) in MVA, TAPSE, LVEF%, mean mitral PG and sPAP (r?=?0.77, P?<?0.001, r?=?0.63; P?<?0.001; r?=?0.42; P?<?0.05; r?=??0.81; P?<?0.001 and r?=??0.65; P?<?0.001). Mitral valve stenosis was associated with significantly impaired coronary flow reserve that significantly improved after PMBV. The improved CFR values were significantly correlated with the gain in the MVA and the improvement in the functions of both left and right ventricles.     

国产球囊导管二尖瓣扩张术中的严重并发症及原因分析

目的 总结分析国产球囊导管二尖辩扩张术(PBMV)严重并发症及导管异常情况的防治。方法 使用不同厂家生产的国产球囊，采用Inoue技术对584例风湿性二尖辩狭窄患者行PBMV治疗。结果 实施手术的584例，成功率98．6％，总严重并发症26例(4．45％)，死亡2例，总病死率(0．3％)。其中室性心动过速、心室囊动8例(1．37％)，房水平分流14例(2．4％)；股静脉血肿6例(1％)，导管折断4例(0．7％)，球囊破裂4例(0．7％)，体循环栓塞3例(0．5％)，急性心包填塞3例(0．5％)，重度二尖辩返流2例(0．3％)，急性左心衰2例(0．3％)。结论 PBMV技术虽已成熟，但仍有一定风险。国产球囊导管质量较进口导管差，更容易出现严重并发症，而且导管也易出现异常情况。但只要严格选择适应证，术前认真做好导管测试，细致检查导管质量，规范操作程序，术中尽量减少大幅度探作，手法轻柔，仍可战少严重并发症的发生及避免一些由于导管引起的并发症。     

Imaging in mitral stenosis: assessment before,during and after percutaneous balloon mitral valvuloplasty

Detailed assessment of mitral valve morphology is required to select patients for successful percutaneous balloon mitral valvuloplasty (PBMV). The mitral valve is routinely imaged using transthoracic and transesophageal echocardiography, which have more recently been supplemented with magnetic resonance imaging, 3D echocardiography and intracardiac echocardiography. The scope of PBMV is expanding and it is increasingly used for patients previously considered to have unfavorable mitral morphology. Here we review the evidence to support the examination of each component of the mitral valve and its surrounding structures and the advantages of each imaging modality. Appropriate echocardiographic views are recommended and periprocedural and postprocedural imaging techniques are discussed.     

Imaging in mitral stenosis: assessment before, during and after percutaneous balloon mitral valvuloplasty

Detailed assessment of mitral valve morphology is required to select patients for successful percutaneous balloon mitral valvuloplasty (PBMV). The mitral valve is routinely imaged using transthoracic and transesophageal echocardiography, which have more recently been supplemented with magnetic resonance imaging, 3D echocardiography and intracardiac echocardiography. The scope of PBMV is expanding and it is increasingly used for patients previously considered to have unfavorable mitral morphology. Here we review the evidence to support the examination of each component of the mitral valve and its surrounding structures and the advantages of each imaging modality. Appropriate echocardiographic views are recommended and periprocedural and postprocedural imaging techniques are discussed.