二尖瓣狭窄伴房颤患者经皮球囊扩张术后电复律的临床疗效

目的　评价二尖瓣狭窄 (MS)伴心房颤动 (AF)患者经皮二尖瓣球囊扩张成型术 (PBMV)及术后即刻电复律成功率与安全性。方法　 5 8例MS伴AF患者均行胸前超声心动图 (TTE)及食道超声心动图 (TEE)检查 ,用Wilkin’s法评分 ,术前、术中、术后测定血流动力学及超声心动图指标的改变 ,术后 32例患者在口服胺碘达隆基础上给予同步电复律。结果　 5 8例MS伴AF患者行PBMV均取得良好的血液动力学及超声心动图指标的改变 ,平均左房压力 (MLAP)、二尖瓣跨瓣压差 (MVPG)在术后有显著的降低 (P <0 .0 0 1) ,二尖瓣口面积 (MVA)较术前明显增加 (P<0 .0 0 1) ,左房内经 (LAD)术后也较术前有显著缩小 (P <0 .0 5 )。PBMV术后电复律即刻成功率为 90 .6 %(2 9/32 ) ,平均随访 2 .1年维持率 84.33%。结论　MS伴AF患者行PBMV术效果良好 ,术后电转复律即刻成功率高 ,随访维持率良好 ,心功能改善明显。

Clinical effect of eardioversion to atrial fibrillation in patients with rheumatic mitral stenosis after percutaneous balloon mitral valvuloplasty

Objective To evaluate the efficacy of cardioversion in patients with mitral stenosis (MS) and atrial fibrillation (AF) after percutaneous balloon mitral valvuloplasty (PBMV). Methods All 58 patients were examined by transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE). The scores of Wilkin's were measured with TTE. Mean left atrial pressure (MLAP) were measured during PBMV. 32 patients were given cardioversion on the basis of taking Amidarone orally. Results PBMV made the hemodynamic and echocardiographic indices modified markedly in 58 patients with MS. MLAP、mitral valve pressure grodient (MVPG) were decreased and MVA were increased markedly compared with that of pre-PBMV markedly, and LAD were decreased after PBMV. The success rate was 90.6% in cardioversion after PBMV immediately. The maintenance rate of sinus rhythmia in was 84.33% by average follow-up 2.1 years. Conclusion PBMV for patients with MS, accompanied by AF is an effective therapy method. Electrical cardioversion after PBMV immediately has good success rate and mainteance rate in follow-up time, and thereby get better cardiac function.