再次经皮球囊二尖瓣成形术39例远期疗效观察

目的 观察经皮球囊二尖瓣成形术后再狭窄的患者,行再次经皮球囊二尖瓣成形术的远期疗效.方法 39例经皮球囊二尖瓣成形术后再狭窄的患者,全部采用改良Inoue法,再次行经皮球囊二尖瓣成形术,并进行远期疗效随访.结果 39例患者再次行经皮球囊二尖瓣成形术,成功36例(成功率为92.3%).再次经皮球囊二尖瓣成形术成功后,患者临床症状及部分血流动力学指标(左心房平均压、二尖瓣瓣口面积、跨瓣压差及肺动脉收缩压)明显改善分别为(24.50±6.54)mm Hg比(9.66±4.21)mill Hg(1 mm Hg=0.133 kPa),(1.05±0.19)cm2比(2.23±0.22)cm2,(17.03±4.52)mm Hg比(7.79±4.07)mm Hg,(58.12±12.68)mm Hg比(31.45±10.02)mm Hg,P均＜0.05];而左心房内径无明显改变(4.71±0.75)cm比(4.07±0.69)cm,P＞0.05]. 36例患者再次经皮球囊二尖瓣成形术后随访12～146(69±23)个月,远期随访可见二尖瓣瓣121面积仍明显大于术前(2.02±0.21)cm2比(1.05±0.19)cm2,P＜0.05],跨瓣压差明显小于术前(9.15±4.11)mm Hg比(17.03±4.52)mm Hg,P＜0.05],且均与近期随访结果相近似分别为(2.02±0.21)cm2比(2.23±0.22)cm2,(9.15±4.11)mm Hg比(7.79±4.07)mm Hg,P均＞0.05];而左心房内径仍无明显改变(4.13±0.71)cm比(4.07±0.69)cm,P＞0.05].远期随访期间,大多数患者心功能及生活质量均明显改善.结论 对于经皮球囊二尖瓣成形术后再狭窄的患者,只要病例选择恰当,手术操作正确,再次行经皮球囊二尖瓣成形术的近期及远期疗效均佳.

Long-term outcome of repeat percutaneous balloon mitral valvuloplasty in patients with mitral restenosis

Objective To observe the long-term outcome of repeat percutaneous balloon mitral valvuloplasty(PBMV)in patients with mitral restenosis.Methods Thirty-nine patients with mitral restenosis post fist PBMV received repeat PBMV with the improved lnoue methed.Patients were followed up for 12 to 146 months.Results Repeat PBMV succeed in 36 out of 39 patients(92.3%).Immediately after repeat PBMV,clinical symptoms and left areal mean pressureLAP,(24.50±6.54)mm Hg(1 mm Hg=0.133 kPa)vs.(9.66±4.21)mm Hg],pulmonary artery systolic pressurePASP,(58.12±12.68)mm Hg vs.(31.45±10.02)mm Hg],mitral valve gradientMVG,(17.03±4.52)mm Hg vs.(7.79±4.07)mm Hg]and area of mitral valve orificeMVA,(1.05±0.19)cm2 vs.(2.23±0.22)cm2]improved signiflcantlv compared to pre-PBMV(all P＜0.05).Left atrial end-diastolic dimension(LAD)remained unchanged post operation(4.71±0.75)cm vs.(4.07±0.69)cm,P＞0.05].Thirty six out of 39 cases could be followed up for a period between 12-146 months(69±23)months.Follow-up,data sbowed that MVA(2.02±0.21)cm2 vs.(2.23±0.22)cm2]and MVG(9.15±4.11)mm Hg vs.(7.79±4.07)mm Hg]were similar as those directly post operation(all P＞0.05).Cardiac function and quality of life were also significantly improved in most patients during follow up.Conclusion Repeat PBMV is safe and effective for most patients with mitral restenosis.