二尖瓣球囊扩张术和机械分离术的临床评价

Clinical evaluation of percutaneous balloon mitral valvuloplasty and mechanical mitral commissurotomy

目的探讨二尖瓣球囊扩张术和机械扩张术治疗二尖瓣狭窄的特点和治疗效果。方法2001年2月～2002年8月,采用二尖瓣球囊扩张术(percutaneous balloon mitral valvuloplasty,PBMV)治疗二尖瓣狭窄52例,评分(7±1);采用机械扩张术(percutaneous mechanical mitral commissurotomy,PMMC)治疗二尖瓣狭窄36例,评分(10±2)。对术后24h、1年的心脏超声检查随访结果进行对比分析。结果PBMV成功率94%(49/52);PMMC成功率92%(33/36)。PBMV后二尖瓣面积(mitral valve area,MVA)(1.7±0.2)cm2,PMMC后MVA(2.1±0.5)cm2,差异有统计学意义(P<0.01)。心包填塞并发症:PBMV发生率5.7%;PMMC5.5%。PBMV和PMMC增加二尖瓣反流面积大于3cm2例数分别占14%(7/52)和10%(3/33),差异有统计学意义(P<0.01)。术后1年,PBMV组需外科换瓣手术3例,PMMC组无手术换瓣病例。结论PBMV和PMMC都是治疗二尖瓣狭窄有效的方法,PBMV技术操作比PMMC简单,扩张后MVA相对小于PMMC组,二尖瓣反流发生PBMV组高于PMMC组,心包填塞是两种方法的共同紧急并发症。PBMV可应用于二尖瓣评分小于8分的患者,PMMC可应用于二尖瓣评分8～12分的二尖瓣狭窄。

Objectives To compare the safety and the efficacy of percutaneous balloon mitral valvuloplasty(PBMV) and percutaneous mechanical mitral commissurotomy(PMMC).Methods From February 2001 to August 2002,PBMV was performed in 52 patients,while PMMC,in 36 patients in Guangdong Provincial Cardiovascular Institute.All patients had clinical and echocardiographic evaluation initially and throughout follow-up of one year or more.Results Successful rate was 94%(49 /52) in PBMV group and 92%(33 /36) in PMMC group.Mitral...