二尖瓣储备功能对二尖瓣球囊扩张术后远期心功能评价的意义

Evaluation of mitral valve reserve on cardiac function after percutaneous balloon mitral valvuloplasty at long-term follow-up in 30 patients

目的 探讨二尖瓣储备在PBMV术后和长期随访中的变化及与心功能关系 ,更客观、全面地评价PBMV术远期疗效。方法 静脉滴注异丙肾上腺素提高心率 ,模拟轻、中、重度体力活动 ,分别于术后、随访期采用超声心动图观察MVA、MVG、Vmax、CO、EF等项指标 ,测量 (LA)。结果 二尖瓣狭窄患者 30例 ,男性 11例 ,女性 19例 ,年龄 (33 3± 7 2 )岁 ,随访时间 (36± 6 36 )个月。PBMV术后静息状态下MVA由 (0 88± 0 2 8)cm2 增加至 (2 0 2± 0 34 )cm2 ,MVG由 (15 2 2± 6 2 5 )mmHg降至 (3 78±1 34 )mmHg(P <0 0 5 ) ,运动负荷状态下MVA由 (2 0 2± 0 34 )cm2 增加至 (2 48± 0 42 )cm2 ,CO由 (5 2 0± 0 84)L min增加 (10 2 0± 0 90 )L min (P <0 0 5 ) ,提示二尖瓣储备、心功能储备部分恢复。经 36±6 36月随访 ,MVA有所下降 [(2 0 2± 0 34 )cm2 降至 (1 72± 0 34 )cm2 ,P <0 0 5 ],MVG、Vmax有所回升[MVG(3 78± 1 34 )mmHg增至 (5 16± 1 78)mmHg ;Vmax(1 12± 0 2 0 )m s增至 (1 48± 0 36 )m s ,P <0 0 5 ],而CO、EF无显著变化 [CO(5 2 0± 0 84)L min至 (4 73± 0 77)L min ;EF(6 6± 7 6 ) %至 (5 8±7 2 ) %,P >0 0 5 ],2 5例患者心功能仍然维持在Ⅰ～Ⅱ级 。

Objective To study changes of mitral valve reserve after mitral valvuloplasty at long term follow up and relation with cardiac function, which might evaluate long term effect of patient with mitral valvuloplasty Methods Heart rates were increased by intravenous isoproterenol to be slight,moderate and strong exercise stress indexes such as MVA, MVG, Vmax, CO and EF were measured by echocardiography after PBMV and long term follow up Results Thirty patients with mitral stenosis, including 11 male, 19 female, age 33 3±7 2 years old, were followed up for 36±6 36 months After PBMV, MVA increased from 0 88±0 28 cm 2 to 2 02±0 34 cm 2 ( P <0 05) and MVG decreased from 15 22±6 25 mm?Hg to 3 78±1 34 mm?Hg ( P <0 05) at rest,while MVA was increased from 2 02±0 34cm 2 to 2 48±0 40 cm 2 ( P <0 05)and CO was increased from 5 20±0 86 L/min to 10 20±0 93 L/min ( P <0 05) by isoproterenol stress echocardiography, which implied that mitral valve reserve and cardiac function reserve restored partly At long term follow up (36±6 36 mon) MVA gradually decreased from 2 02±0 34 cm 2 to 1 72±0 34 cm 2 ( P <0 05), MVG, Vmax increased again (MVG 3 78±1 34 mm?Hg to 5 16±1 78 mm?Hg; Vmax 1 12±0 20 m/s to 1 48±0 36 m/s, P <0 05),while CO, EF, had no significant change at rest (CO 5 20±0 84 L/min to 4 73±0 77 L/min; EF 66±7 6% to 58±7 2%, P >0 05) cardial function remained Ⅰ～Ⅱ degree NYHA and PBMV or valve replacemant were not performed in 30 patients (83 3%), data from isoproterenol stress echocardiography showed that mitral valve reserve did not decreased with MVA decremention at rest and cardiac function reserved, diameter of left atrium decreased remarkbly Conclusion MVA enlarged and mitral valve restored partly by PBMV Mitral valve reserve is more important than MVA only at rest condition to evaluate cardiac function At long term follow up, MVA Gradually decreased, while cardiac function reserved in good condition MVA at rest condition should not be unique criteria of restenosis after valvuloplasty MVA and mitral valve reserve are important predictive factors in long term cardiac function