二尖瓣狭窄合并左心房血栓患者的经皮二尖瓣球囊成形术

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合并左心房血栓的临床疗效和安全性。方法　 2 7例风湿性二尖瓣狭窄合并左心房血栓患者进行PBMV ,19例食管超声心动图 (TEE)有左心房内新鲜血栓者术前经华法令抗凝治疗 3～ 6个月。结果　 2 7例风湿性二尖瓣狭窄合并左心房血栓患者进行PBMV均成功。 19例TEE有左心房内新鲜血栓者 ,PBMV术前经华法令抗凝治疗后 ,TEE复查示 9例左心房血栓消失 ,10例左心房内血栓明显缩小 ,机化为高强回声团块的陈旧性血栓 ;5例经胸心脏超声发现左心房陈旧性血栓 ,未行TEE也未予华法令治疗者 ,术中 1例发生脑栓塞。其余患者均无并发症发生。结论　对风湿性二尖瓣狭窄伴有心房纤维颤动患者 ,PBMV前应常规行TEE检查 ;二尖瓣狭窄伴左心房血栓者经充分抗凝治疗后行PBMV是安全可行的。     

经皮二尖瓣球囊扩张术对内皮素及其他内分泌激素的影响

目的　探讨风湿性心脏病二尖瓣狭窄患者在行经皮二尖瓣球囊扩张术 (PBMV)前后内皮素 (ET)以及其他内分泌激素变化的意义。方法　 14例风湿性心脏病二尖瓣狭窄患者作PBMV的前后测定血浆ET、心钠素 (ANF)、肾素 (PRA)、血管紧张素Ⅱ (AⅡ )以及血流动力学参数。结果　在PBMV前血浆ET(16 1.94± 5 0 .6 1) pg/ml[术后为 (80 .4 0± 19.13)pg/ml,P <0 .0 0 1];ANF(2 39.34± 87.0 0 )pg/ml[术后为 (10 5 .0 0±4 1.4 6 )pg/ml,P <0 .0 1];PRA(3.2 7± 1.0 5 )pg/ml[术后为 (1.38± 0 .78)ng/ml,P <0 .0 1];AⅡ (16 1.2 6± 36 .4 5 4 ) pg/ml[术后为 (89.4 4± 2 3.70 )pg/ml,P <0 .0 0 1],均较手术前明显降低 ,但仍显著高于对照。PBMV后ET的变化 (ΔET)与左房压 (ΔLAP)、二尖瓣跨压差 (ΔMPG)、二尖瓣面积 (ΔMAV)以及峰值流速 (ΔPV)变化有显著相关性。结论　本研究证实PBMV扩大瓣口面积使LAP下降 ,ET等其他内分泌激素含量随之下降 ,两者有显著相关性     

疑难特殊病例行经皮球囊导管左房室瓣成形术15例

目的　探讨风湿性左房室瓣狭窄的疑难特殊病例行经皮左房室瓣狭窄球囊成形术(PBMV)技术要点。方法　选择15例患者,其中左侧途径2例,巨大右房3例,巨大左房5例,左肺不张1例,脊柱侧弯3例,脊柱结核1例。术前左房室瓣口面积(MVA) 0 .85±0 .2 0cm2 。用传统的Inoue球囊技术结合术中情况对主要器械形状结构进行重塑形。结果　全部病例手术操作均获成功,左房室瓣口面积1.94±0 .16cm2 ,临床症状明显好转,无一例发生左房室瓣撕裂至中重度关闭不全、心脏穿孔等严重并发症。结论　疑难特殊病例可同样行经皮左房室瓣球囊成形术,只要术者经验丰富,结合患者心脏解剖特点,重塑主要器械,PBMV安全有效     

再次球囊扩张术治疗风湿性左房室瓣狭窄的疗效评价

目的　评价左房室瓣球囊扩张术(PBMV)后再狭窄的病例再次作球囊扩张术的临床效果。方法　5 0 1例接受球囊扩张术的患者,分为首次球囊扩张组(45 3例)及再次球囊扩张组(48例) ,球囊扩张前后用超声及导管测左房室瓣口面积(MVA)、左房前后径(LAD)、左房压(LAP) ,比较两组患者这些参数在PBMV前后的变化情况。结果　首次球囊扩张组与再次球囊扩张组PBMV后MVA分别由术前的(0 .86±0 .2 5 )、(1.0 9±0 .2 6 )cm2 增加至(1.87±0 .2 7)、(1.86±0 .30 )cm2 ;LAD分别由(46 .0 9±7.5 7)、(49.74±9.88)mm减少至(41.6 4±7.97)、(45 .4 1±8.4 4 )mm ;LAP分别由(2 9.2 6±6 .6 4 )、(30 .5 2±5 .2 8)mmHg下降至(16 .14±5 .13)、(2 2 .35±7.83)mmHg(P均<0 .0 0 1) ;再次球囊扩张组较首次球囊扩张组术后MVA增加的幅度(术前术后的差值)小(0 .72±0 .2 2vs 0 .99±0 .2 7,P <0 .0 0 1) ;左房压下降的幅度则较低(8.33±4 .17vs 13.0 7±5 .77,P <0 .0 0 1) ;两组各种并发症及总的并发症均未见统计学差异。结论　球囊扩张术后再狭窄的患者,再次作球囊扩张术仍然是安全有效的,但效果不如首次扩张组     

一步法治疗中重度二尖瓣狭窄的研究(附492例报告)

目的　研究一步法经皮球囊扩张术治疗中重度二尖瓣狭窄 15年的经验及长期随访的情况。方法　摒弃传统的三步法 ,采用一步法经皮经房间隔穿刺球囊扩张治疗二尖瓣狭窄。本组共 4 92例风湿性心脏病二尖瓣狭窄患者 ,其中男 15 6例 ,女 336例 ,年龄 4 1 2±10 5岁(15～ 6 8岁 )。结果　 4 92例二尖瓣球囊扩张术手术时间 36 5± 12 1min ,成功率 98 2 % (4 83/ 4 92 ) ,术后二尖瓣口面积从 0 89±0 18cm2 增加至 2 2 1± 0 4 1cm2 。 10 5例随访 8～ 98个月 ,二尖瓣再狭窄率为 11 4 % (12 / 10 5 ) ,远期死亡率为 2 9% (3/ 10 5 )。结论　一步法经皮球囊扩张术治疗重症二尖瓣狭窄成功率高 ,近远期疗效均佳。     

经皮二尖瓣球囊扩张术的疗效评价

13例经皮二尖瓣球囊扩张术(PBMV),12例获得成功。术后二尖瓣开口面积由1.13±0.31cm~2扩大至1.57±0.50cm~2(P<0.05);左房平均压由2.45±0.50kPa降至1.29±0.57kPa(P<0.001);跨二尖瓣压力阶差由1.92±0.60kPa降至0.70±0.46kPa(P<0.001);肺动脉平均压由3.45±0.8lkPa降至2.22±1.35kPa(P<0.05);心排血量由2.95±0.49L/min提高到4.53±0.29L/min(P<0.001)。说明PBMV是一种近期疗效显著、创伤小、毋须开胸的治疗风湿性二尖瓣狭窄的有效方法。     

球囊扩张术治疗风湿性左房室瓣狭窄并左心耳血栓的安全性评价

目的　评价风湿性左房室瓣狭窄并左心耳血栓患者行左房室瓣球囊扩张术(PBMV)的可行性与安全性。方法　4 0例风湿性左房室瓣狭窄并左心耳血栓的患者,均经尿激酶溶栓5～7d后血栓不能溶解,继续口服华法林3～6个月后仍有血栓。观察PBMV后二口面积(MVA)、左房前后径(LAD)、左房平均压(LAP)的变化及术中与术后急性期体循环栓塞发生率、心功能的变化。结果　术后患者MVA由术前的0 .83±0 .19增加至1.86±0 .32 (P =0 .0 0 0 ) ;LAD由4 8.94±8.2 8下降至4 1.2 1±6 .2 5 (P =0 .0 0 2 ) ;LAP由2 8.89±6 .5 9下降至16 .83±6 .94 (P =0 .0 0 0 ) ;术后心功能均显著改善;术中2例(5 % )发生脑栓塞。结论　只要技术熟练,小心操作,风湿性左房室瓣狭窄并左心耳血栓作球囊扩张术仍具有一定的可行性与安全性,但其安全性是相对的,与术者操作手法有关     

应用国产球囊行经皮穿刺二尖瓣成形术

目的 :　评估利用国产球囊导管行经皮二尖瓣成形术治疗风湿性二尖瓣狭窄的疗效。材料和方法 :回顾性分析2 37例风湿性二尖瓣狭窄患者 (其中男 79例 ,女 15 8例 ,年龄 15～ 6 7岁 ,平均 41.2± 15 .3岁 ) ,利用国产球囊导管、美国OEC96 0 0型小C臂X光机行经皮穿剌二尖瓣球囊扩张术的疗效。结果 :2 37例中 ,成功率为 97.5 % ( 2 31/2 37) ,其中 12 9例进行了随访 ,术后及随访左房内径、二尖瓣口面积、跨瓣压差均较术前明显改善 ,平均随访时间 ( 34± 12 )个月 ,5例出现再狭窄 ,其中 4例再次PBMV术成功 ,1例行瓣膜置换术。结论 :利用国产球囊导管行PBMV近期疗效显著 ,远期疗效良好 ,价格低廉 ,值得临床推广应用。     

左心耳封堵联合二尖瓣球囊扩张治疗非风湿性二尖瓣狭窄伴心房颤动

目的 分析非风湿性二尖瓣狭窄伴心房颤动患者经皮左心耳封堵术和二尖瓣球囊扩张术(PBMV)临床特点.方法 入选2018年1月至2020年10月上海健康医学院附属周浦医院确诊的4例非风湿性二尖瓣狭窄伴心房颤动患者,给予左心耳封堵术及左心耳封堵联合PBMV术治疗,对患者临床表现、影像学特征及治疗预后进行分析.结果 4例患者年...     

67例二尖瓣球囊成形术临床分析

经皮二尖瓣球囊成形术治疗二尖瓣狭窄67例,63例成功(94%),术后左房平均压由24+8mmHg 降至15+7mmHg(P<0.001);跨瓣压差由21±9mmhg 降至10±8mmhg(P<0.001);左房内径由49±7mmhg 降至43±7mmhg(P<0.001)二尖瓣口面积由1.1cm±0.2cm 增至2.1cm±0.3cm(P<0.001);心输出量由5.7±1.4升/分增至6.3±1.6升/分(P<0.001)。MR 系影响 PTMV 术的效果的重要因素,术中产生 MR 主要决定二尖瓣病理形态结构,与采用球囊类型无关。术后近期及远期疗效稳定。国产球囊可与进口球囊相媲美。     

经皮穿刺球囊二尖瓣成形术80例

目的：评价经皮穿刺球囊二尖瓣成形术（ＰＢＭＶ）治疗风心病二尖瓣狭窄的方法和疗效。材料和方法：应用Ｉｎｏｕｅ单球囊技术治疗风心病二尖瓣狭窄患者８０例。结果：与术前比较,心尖部舒张期杂音明显减弱或消失;二尖瓣口面积均明显增大;左房平均压、二尖瓣跨瓣压差明显下降;心输出量明显增加;心功能提高１级以上;随访结果满意。结论：ＰＢＭＶ治疗风心病二尖瓣狭窄安全、可靠;对老年和二尖瓣钙化者应用小球囊顺序扩张安全且疗效满意;法华令可能具有溶栓作用,对拓宽治疗范围可能有重要临床意义     

Magnetic resonance evaluation of mitral stenosis

In order to study magnetic resonance (MR) abnormalities in mitral stenosis electrocardiogram (ECG)-gated MR imaging was performed with a 2.0 T MR system in 41 patients with mitral stenosis before catheterization. Mean transverse diameter of the left atrium was 8.9±1.4 cm and anteroposterior diameter was 5.1±1.0 cm, indicating significant enlargement. Homogeneous or inhomogeneous flow-related signals in ventricular diastole were detected in the left atrial cavity in 32 cases (78%), and in the atrial appendage in 35 cases (85%). In 21 patients having a mean wedge pulmonary arterial pressure higher than 20 mm Hg, 20 patients (95%) showed flow-related signals in ventricular diastole. Other MR findings were mitral valve doming in diastole, flow-related signal in the pulmonary artery during systole, and left atrial thrombi.     

特殊情况的左房室瓣球囊扩张术疗效分析

目的　分析和总结伴有特殊情况的左房室瓣狭窄球囊扩张术(PBMV)的临床疗效和安全性。方法　收集我院自1986年12月至2 0 0 5年1月施行的2 30 0例风湿性心脏病左房室瓣狭窄(MS)病例,其中有特殊情况者6 2 1例。包括非单纯MS(合并左房室瓣关闭不全或主闭)者32 8例;非单纯的MS伴巨大左房者15例;巨大左房者10 6例;左房血栓者5 2例;巨大左房及左房血栓者4例;PBMV或左房室瓣闭式分离术后者79例;PBMV或左房室瓣闭式分离术后非单纯的MS者34例;妊娠大咯血者2例。采用Inoue球囊技术。结果　手术成功率98.5 % ,失败率0 .2 % ;发生严重并发症8例,并发症为1.3% ,其中急性左心衰2例,低心排1例,脑栓塞2例,心脏压塞3例。因急性左心衰、低心排、心脏压塞、脑栓塞造成的死亡各1例。结论　随着操作技巧的不断完善,许多伴有特殊情况的PBMV可安全、有效的接受手术。但术前一定要全面评价瓣膜、心功能、血栓情况     

43例机器人二尖瓣置换术后单中心中长期随访结果

目的 总结机器人二尖瓣置换术(MVR)的手术经验及远期疗效.方法 选择2007年1月-2015年1月在解放军总医院心血管外科应用达芬奇机器人外科系统完成二尖瓣置换术的43例患者,年龄19~65(47±11)岁,NYHA心功能分级Ⅰ级6例、Ⅱ级30例、Ⅲ级7例,左室射血分数54%~78%(64.0%±7.1%),其中20例患者伴有心房纤颤、32例患者伴有风湿性二尖瓣狭窄.所有患者均在体外循环建立后利用达芬奇机器人系统切开左心房,进行机械或者生物二尖瓣置换,利用Cor-KnotTM打结装置的缝线夹子固定人工瓣膜.术前和术后均行经食管超声心动图检查(TEE),术后随访观察患者的手术效果及不良事件发生情况.结果 所有患者均顺利完成手术,无一例转为正中胸骨切开术,无死亡病例;手术时间292±62(140~450)min,体外循环时间124±26min,主动脉阻断时间88±21min;术后机械通气支持时间为15±5h,危重症监护室停留时间为4±1d,未发生心肌梗死、室性心动过速或者失血过多等并发症.所有患者均获随访,随访时间1个月~6年,中位时间3.5年,随访期间无死亡、中风、由假体性心内膜炎或者假体失效引起的二次手术等,但有17例(39.5%)患者术后仍有心房颤动症状.结论 机器人二尖瓣置换术安全有效并具有良好的长期效果.     

超声心动图用于经皮球囊二尖瓣成形术中的价值

目的评价超声心动图在经皮球囊二尖瓣成形术(PBMV)前后的应用价值.材料和方法对38例PBMV患者术前(1～7天)行超声心动图二尖瓣计分法预测,术后(24～48h)行超声心动图观察随访.32例分别于PBMV术后3、6个月和1年进行超声心动图跟踪随访.结果术前38例预测与PBMV手术符合率100%,各项测值除左室(LV)外,PBMV术前后比较均有显著差异(P＜0.005).结论超声心动图二尖瓣计分法预测PBMV具有较大的临床应用价值.左房缩小率(LASR)＞10%是估价PBMV有效的有用指标.     

Mitral valve flow measured with cine MR velocity mapping in patients with ischemic heart disease: comparison with doppler echocardiography

Diastolic function is an important element of overall left ventricular function. The pattern of flow across the mitral valve is commonly used as a measure of diastolic ventricular function. Magnetic resonance (MR) velocity mapping of blood flow across the mitral valve was compared with Doppler echocardiography. Nineteen patients with known coronary artery disease (mean age. 62 years: 11 with previous myocardial infarction) were studied. The mean value of peak early filling velocity (± standard deviation) was 60.1 cm/sec ± 14.3 with the MR method and 59.4 cm/sec ± 13.7 with echocardiography (P = 0.732). The mean difference between the two measurements (95% confidence interval) was ?0.8 cm/sec (?5.2 cm/sec. +2.2 cm/sec). The mean value of early deceleration was 4.3 mlsec² ± 1.5 with the MR method and 4.0 m/sec² ± 1.5 with echocardiography (P = 0.073). The mean Werence was ?0.4 cm/sec² (?0.92 cm/eec². +0.05 cm/sec²). The mean value of peak atriosystolic velocity was 51 cm/sec ± 14.6 with the MR method and 62 cm/sec ± 17.2 with echocardiography (P = 0.002). The mean difference was ?11 cm/sec (?18.1 cm/sec, ?3.45 cm /sec). Peak atrial filling was consistently lower with the MR method than with echocardiography. Time-averaged measurements of ventricular fflling with MR velocity mapping are an accurate measure of early diastolic filling but underestimate the velocity of atriosystolic fflling.     

Geometric differences of the mitral valve apparatus in atrial and ventricular functional mitral regurgitation

BackgroundFunctional mitral regurgitation (FMR) occurs in patients with annular dilation (atrial, aFMR) or patients with left ventricular (LV) disease (ventricular, vFMR). Meticulous understanding of the mechanisms underpinning regurgitation is crucial to optimize therapeutic strategies.MethodsPatients with moderate-severe FMR were identified from a registry of patients referred for transcatheter mitral valve intervention. In addition, controls without cardiovascular disease were identified. Differences in the geometry of the LV and mitral valve apparatus (including leaflet and tenting geometry, papillary muscle displacement and movement, annular dimensions, and dynamism) between atrial and ventricular FMR, and control subjects, were assessed using multiphasic cardiac CT.ResultsOf 183 FMR patients, 18 patients (10%) were found to have aFMR. The remaining patients had either ischemic or non-ischemic ventricular FMR. In aFMR, both increasing LV end-systolic volume (rho 0.701, p ?< ?0.01) and left atrial volume (rho 0.909, p ?< ?0.01) were associated with larger annular area. By contrast, in vFMR larger annular area was most strongly associated with larger left atrial volume (rho 0.63, p ?< ?0.01). In controls, increased annular area was associated with larger LVEDV (rho 0.78, p ?< ?0.01) and LVESV (rho 0.824, p ?< ?0.01), but not left atrial size (rho 0.16, p ?= ?0.45).Ventricular FMR comprised apicolaterally displaced, akinetic posteromedial papillary muscles, resulting in pronounced leaflet tethering, leaflet elongation compared to controls, and only modest relative LA dilatation. Compared to vFMR, aFMR was characterised by marked relative annular dilation, smaller but discernible mitral valve tenting, shorter leaflet lengths when related to annular size, but normal papillary geometry.ConclusionFMR is characterised by multiple changes within the mitral valve complex. Atrial and ventricular FMR differ significantly in terms of the drivers of annular size, and geometry and function of the subvalvular apparatus. This highlights the need to consider these as separate disease entities.     

A simplified D-shaped model of the mitral annulus to facilitate CT-based sizing before transcatheter mitral valve implantation

BackgroundThe nonplanar, saddle-shaped structure of the mitral annulus has been well established through decades of anatomic and echocardiographic study. Its relevance for mitral annular assessment for transcatheter mitral valve implantation is uncertain.ObjectiveOur objectives are to define the methodology for CT-based simplified “D-shaped” mitral annular assessment for transcatheter mitral valve implantation and compare these measurements to traditional “saddle-shaped” mitral annular assessment.MethodsThe annular contour was manually segmented, and fibrous trigones were identified using electrocardiogram-gated diastolic CT data sets of 28 patients with severe functional mitral regurgitation, yielding annular perimeter, projected area, trigone-to-trigone (TT) distance, and septal-lateral distance. In contrast to the traditional saddle-shaped annulus, the D-shaped annulus was defined as being limited anteriorly by the TT distance, excluding the aortomitral continuity. Hypothetical left ventricular outflow tract (LVOT) clearance was assessed.ResultsProjected area, perimeter, and septal-lateral distance were found to be significantly smaller for the D-shaped annulus (11.2 ± 2.7 vs 13.0 ± 3.0 cm²; 124.1 ± 15.1 vs 136.0 ± 15.5 mm; and 32.1 ± 4.0 vs 40.1 ± 4.9 mm, respectively; P < .001). TT distances were identical (32.7 ± 4.1 mm). Hypothetical LVOT clearance was significantly lower for the saddle-shaped annulus than for the D-shaped annulus (10.7 ± 2.2 vs 17.5 ± 3.0 mm; P < .001).ConclusionBy truncating the anterior horn of the saddle-shaped annular contour at the TT distance, the resulting more planar and smaller D-shaped annulus projects less onto the LVOT, yielding a significantly larger hypothetical LVOT clearance than the saddle-shaped approach. CT-based mitral annular assessment may aid preprocedural sizing, ensuring appropriate patient and device selection.     

Radionuclide assessment of left ventricular diastolic function in patients with mitral stenosis before and after percutaneous transvenous mitral commissurotomy; use of list mode method in patients with atrial fibrillation

To evaluate the effect of percutaneous transvenous mitral commissurotomy (PTMC), equilibrium radionuclide angiocardiography was performed in eight patients with mitral stenosis who had atrial fibrillation. Accurate cardiac function in patients with atrial fibrillation is difficult to assess, since the wide fluctuation of cardiac cycle makes the ventricular hemodynamics variable. A new processing algorithm was devised to make multiple gated images discriminated from a heart rate distribution histogram. We obtained about 1,000 beats data by list mode acquisition, and processed a heart rate distribution histogram. The data in the area +/- 5% of the most frequent heart rate were converted into frame mode and a representative time activity curve was derived. Mitral valve area calculated by echocardiography increased from 1.3 +/- 0.5 to 2.0 +/- 0.6 (cm2) significantly (p less than 0.01). The mean transmitral pressure gradient measured by catheterization decreased from 12.4 +/- 5.9 to 4.9 +/- 3.7 (mmHg) significantly (p less than 0.01) and the clinical symptoms improved in all patients. The change in left ventricular ejection fraction from 43 +/- 9 to 48 +/- 13 (%) was not statistically significant, but peak filling rate (PFR) derived from the time activity curve increased from 1.5 +/- 0.3 to 2.0 +/- 0.4 (EDV/sec) significantly (p less than 0.01). Thus PFR is a noninvasive parameter that can evaluate the effect of PTMC.