老年前期及老年患者经皮球囊二尖瓣成形术

Percutaneous balloon mitral valvuloplasty in the senile and pre senile patients with mitral stenosis

目的： 报道应用经皮球囊二尖瓣成形术治疗７０例老年前期及老年风湿性二尖瓣狭窄患者的疗效。 方法：７０ 例患者中，男１８例，女５２ 例；３６ 例为单纯二尖瓣狭窄或二尖瓣狭窄伴轻度二尖瓣关闭不全或轻度主动脉瓣关闭不全，３４例伴有轻度二尖瓣叶钙化或瓣下结构的病变，均采用改良ｌｎｏｕｅ单球囊法行ＰＢＭＶ。 结果：７０例中６７例成功，失败３ 例，其中１例为术中急性心包填塞，２ 例术后出现中度二尖瓣关闭不全。术后即刻，左房压、肺动脉压下降，瓣口面积增加，心功能改善。４２例患者随访（５２．４±２４．５）个月，１例出现再狭窄，１ 例原因不明猝死，１ 例因二尖瓣反流行瓣膜置换术，其余患者心功能和生活质量明显改善。结论：只要患者条件适宜，技术操作适当，对年龄≥５０ 岁伴轻度二尖瓣或（和）主动脉瓣反流，瓣膜钙化或瓣下结构病变的二尖瓣狭窄患者，也可安全有效地施行球囊二尖瓣成形术。

Objectives: To report the result of percutaneous balloon mitral valvuloplasty (PBMV) in 70 senile and pre senile patents with rheumatic mitral stenosis. Methods:Of the 20 patients, 18 male and 52 female, there were 34 cases with mild mitral valve calcification or submitral apparatus lesions, 24 cases with mild mitral regurgitation, 8 cases with aortic regurgitation. PBMV was performed in 70 cases. Results:PBMV was successful in 67 cases, with the mitral valve area increased. Left atrial pressure (LAP)、pulmonary artery pressure decreased, the heart function and clinical symptom improved remarkedly after PBMV. PBMV was failure in 3 cases. Cardiac tamponade in 1 patients, moderate mitral regurgitation in two cases. 42 cases were followed at a mean of (52.4±24.6) months (rage 12 months to 9 years)after PBMV. Echocardio graphic restenosis was seen in 1 patients. death in 1 patient, mitral valve replacement in patients, cardiac function improved further in 39 patients. Conclusion: PBMV can be performed safely and successfully in selected patients≥50 years old with the mild mitral valve calcification and regurgitation or submitral apparatus lesions.