二尖瓣球囊成形术在二尖瓣狭窄合并左房血栓形成中的应用

Evaluation of percutaneous balloon mitral valuloplasty in patients with mitral stenosis complicated with left atrial thrombi

目的:评价经皮二尖瓣球囊成形术治疗二尖瓣狭窄伴左房血栓形成的疗效、安全性。方法:56例伴有左房血栓形成患者术前经正规华法林抗凝治疗后,采用改良的房间隔定位法即"井"字定位法及运用跨二尖瓣技巧对二尖瓣狭窄伴左房血栓形成患者行逐步球囊扩张,以血流动力学评估手术前后即刻左房压、二尖瓣跨瓣压差及二尖瓣口面积,并进行手术后随访,观察有无体循环血栓栓塞等并发症。结果:与术前相比较,术后左心房平均压下降[(21.6±3.7)mmHg(1mmHg=0.133kPa)∶(35.1±4.2)mmHg]、二尖瓣跨瓣压差显著下降[(7.1±3.1)mmHg∶(16.8±4.5)mmHg)],二尖瓣口面积增大[(1.65±0.28)cm2∶(0.71±0.14)cm2],差异极有统计学意义(均P<0.01),心功能明显改善。超声心动图随访结果表明,经皮二尖瓣球囊成形术疗效稳定,无血栓栓塞并发症发生。结论:左房血栓形成仅为经皮二尖瓣球囊成形术的相对禁忌证,对于经充分华法林抗凝治疗的患者而言,经皮二尖瓣球囊成形术操作技术的改进能明显改善其症状,是安全有效的。

Objective：To evaluate the efficacy and safety of percutaneous baloon mitral valvuloplasty（PBMV） in patients with mitral stenosis（MS） complictated with left atrial thrombi. Method：Fifty-six Patients with MS complictated with left atrial thrombi were received improved PBMV which mainly included：a modified way of atrial septal puncture and technique across the mitral valve. Before PBMV,all cases was received warfarin orally.The hemodynamic evaluation criterias included left atrial pressure（LAP）,mean gradient across the mitral valve and calculation of mitral valve area（MVA） before and immediately after the ballon. Long term followed up were made and complication as systematic thromboembolis were observed. Result：The LAP ,mean gradient across the mitral valve decreased. MVA increased and the heart function classification improved markedly. The follow-up result showed that the effect of PBMV was constant. No systemic thromboembolism occurred.Conclusion：Improved PBMV may be an effective and safe procedure for patients with MS complictated with left atrial thrombi after sufficient anticoagulation treatment.