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

The therapeutic effect analysis of percutaneous balloon mitral valvoplasty with special cases

Objective To analyse and summarize clinic effect and safety of percutaneous balloon mitral valvoplasty(PBMV) with special cases. Methods Among 2300 mitral stenosis(MS) patients underwent PBMV from December 1986 to Jan 2005, There were 621patients with special cases,437females and 184males.The age was 20-72years old, Including 328non-simple MS,15non-simple MS and enormous left atrial;106 enormous left atrial;52left atrial thrombi; 4left atrial thrombi and enormous left atrial;79 Post-PBMV or Post-surgical closed mitral valvotomy (CMV);34 non-simple MS and Post-PBMV or Post-CMV. The Inoue balloon technique was adapt. Results Operative successful rate was 98.5%,4cases defeat. (defeat rate 0.2%),serious complication occurred in 8pations(1.3%),2 acute left ventricular failure,1 low cardiac output,3 acute cardiac tamponade, 2 cerebral thromboembois. Conclusions Many special cases can be comducted safely and effectively along with more operation and improve technique,but valves,the grade of cardiac function and thrombi should be evaluated completely before operation.