老年人经皮球囊二尖瓣成形术

Evaluation on percutaneous balloon mitrai valvuloplasty in the elderly patients with mitrai stenosis

目的:探讨经皮球囊二尖瓣成形术(PBMV)治疗老年人二尖瓣狭窄(MS)的临床疗效。方法:采用Inoue法对13例年龄≥60岁的MS患者施行PBMV,其中10人接受5-12年中长期随访,收集术前、术后及随访结束时有关心脏参数,进行分析比较。结果:术前、术后及随访5-12年测得参数:(1)二尖瓣瓣口面积(MVA)分别为:0.96±0.15 cm2、1.73±0.27 cm2、1.51±0.32 cm2(P<0.01),后两者与术前比较P<0.01;(2)二尖瓣跨瓣压分别为2.82±1.51 kPa、0.87±0.34 kPa、1.52±0.41 kPa,后两者与术前比较P<0.01;(3)左房平均压分别为3.82±1.73kPa、1.81±0.95 kPa、2.16±0.52 kPa,后两者与术前比较P<0.01。术后心功能改善1级以上者100％,术后5-12年随访心功能仍维持在Ⅱ级以上者占80％,5-12年后再狭窄发生率20％。结论:PBMV治疗老年人MS的近期及中远期疗效均满意,未见严重并发症,是一种安全有效的治疗方法。

Objective: To asses the effect of percutaneous balloon mitrai valvuloplasty (PBMV) in the elderly patients with mitrai stenosis (MS). Methods: PBMV was performed successfully with Inoue technique in 13 aged (≥60 years old) patients with MS. Ten patients received 8 years long term follow-up (range from 5 to 12 years). Results: Before, right after procedure and at 8 years follow-up, the mean mitrai valve areas were 0. 96±0. 15 cm2, 1. 73±0. 27 cm2 (P<0. 01), 1. 51±0. 32 cm2 (P<0. 01) respectivelyi the transmitral pressure gradient were 2. 82±1. 51 kPa, 0. 87±0. 34 kPa (P<0. 01) and 1. 52±0. 41 kPa (P<0. 01) respectively i the mean left atrial pressure were 3. 82±0. 73 kPa, 1. 81±0. 95 kPa (P<0. 01) and 2. 16±0. 52 kPa (P<0. 01) respectively. All the 13 patients had a significant improvement at least one grade in cardiac function right after PBMV. Among the 10 patients who received long-term follow-up, 8 of them (80%) remained good cardiac function (≥grade Ⅱ ); two of them (20%) had restenosis. Conclusion: PBMV is a safe and effective method to treat the elderly patients with MS.