经皮球囊二尖瓣成形术的远期疗效

目的 观察经皮球囊三尖瓣成形术近期及远期疗效.方法 自1992年4月至2008年11月采用Inoue单球囊法对1768例风湿性心脏病二尖瓣狭窄患者行经皮球囊二尖瓣成形术(PBMV)治疗.对其中自1992年4月至1998年8月426例术后10年患者进行随访.球囊扩张前后均采用同步记录左心房和左心室压力,计算二尖瓣跨瓣压差.术前、术后及随访中均采用超声心动图检查和临床心功能评价.结果 1748例完成PBMV治疗,成功率为98.86%.左心房平均压由术前(38±7)mm Hg(1 mm Hg=0.133 kPa)下降至(12±4)mm Hg(P<0.001),二尖瓣平均跨瓣压差由术前(28±6)mm Hg下降至(8±3)mm Hg(P<0.001),二尖瓣口面积由术前(0.98±0.26)cm~2增加至(1.97±0.39)cm~2(P<0.001).主要并发症为死亡2例,急性心包填塞1例,肺水肿1例,重度二尖瓣反流12例,脑栓塞2例.426例PBMV术后10年随访,心功能仍然维持在纽约心功能Ⅰ～Ⅱ级而未冉进行PBMV或换瓣术者288例(67.6%),冉狭窄140例(33.3%),死亡31例(7.5%).结论 PBMV是治疗风湿性心脏病二尖瓣狭窄的有效方法 .

Long-term outcome of percutaneous balloon mitral valvuloplasty in patients with rheumatic mitral valve stenosis

Objective To observe the outcome of percutaneous balloon mitral valvuloplasty (PBMV) in patients with rheumatic mitral valve stenosis. Methods From April 1992 to November 2008, 1768 patients underwent PBMV in our hospital. Clinical and echocardiographic follow up data were analyzed in 426 patients from April 1992 to August 1998. Left atrial pressure and the mitral valve gradient (MVG) were measured before and immediately after PBMV in all patients. Results PBMV was successful in 1748 out of 1768 patients (98.86%). Left atrial pressure decreased from (38±7) mm Hg(1 mm Hg=0.133 kPa)to (12±4) mm Hg (P<0.001), MVG decreased from (28±6) mm Hg to (8±3) mm Hg (P< 0.001) and the area of the mitral valve increased from (0.98±0.26) cm~2 to (1.97±0.39) cm~2(P< 0.001) post PBMV. The main complications included death (n=2), acute pericardial effusion (n=1), severe mitral regurgitation (n=12), cerebral embolism (n=2) and pulmonary edema (n=1). Ten years follow up was finished in 426 patients and 288 patients (67.6%) were still in NYHA class Ⅰ or Ⅱ without mitral valve replace operation or repeated PBMV, restenosis was evidenced in 140 patients (33.3%) and 31 patients dead (7.5%). Conclusion PBMV was an effective therapy option for patients with rheumatic mitral valve stenosis.