经皮二尖瓣球囊扩张术严重并发症及防治

目的 总结分析经皮二尖瓣球囊扩张术（PBMV）严重并发症及防治。方法 采用Inoue技术。96％采用自制单球囊扩张管。对1200例风心病二尖瓣狭窄患者行PBMV术治疗。结果 实施手术1200例次,成功率98.82％。总严重并发症53例（4.4％）。总死亡率0.33％,死亡4例。其中,急性肺水肿.心脏骤停各1例,急性左心衰,心脏低排2例。急性重度二尖瓣关闭不全5例（0.42％）。急性心脏穿孔心包填塞8例（0.66％）。严重心律失常28例（2.3％）。急性左心衰竭4例（0.33％）。体循环栓塞8例（0.66％）。结论 经皮二尖瓣球囊扩张术虽已技术成熟,仍有一定的风险。严格选择适应证的病人,规范操作,严加防范,是减少并发症的关键。

The serious complications of percutaneous balloon mitral valvuloplasty and their management

Objective To analyze the serious complications of percutaneous balloon mitral valvuloplasty (PBMV). Methods Between October , 1986,and November, 2000, 1200 patients with rheumatic mitral stenosis age 9-66 older underwent PBMV by Inoue Way. 98% of the balloon catheters were self-made and single balloon catheters.Results Operative successful rate was 98.82% . Serious complications occurred in 51 patients or (4.4%), including 4 cases of death (0.33%), 5 acute serious mitral regurgitation (0.42%), 8 acute cardiac tamponade (0.66%), 28 severe arrhythmia (2.3%), 4 acute left ventricular failure and acute pulmonary edema (0.33%), and 8 systemic thromboembolis. The four cases of death included 1 with acute pulmonary edema, 1 with cardiac arrest, and 2 with acute left ventricular failure with low cardiac output. Conclusion The results demonstrate that PBMV is an efifective and reliable procedure in the treatment of rheumatic mitral stenosis, but a marked decreasement in complication rates is attributable to refinement of patient selection criterion, technical advance in procedure, and strictly management of patients.