经皮球囊二尖瓣成形术治疗二尖瓣狭窄合并房颤的疗效

Efficacy of percutaneous balloon mitral valvuloplasty in patients with mitral stenosis and atrial fibrillation

目的 对二尖瓣狭窄 (MS)合并房颤 (Af)患者经皮球囊二尖瓣成形成术 (PBMV)后 3～ 11年的随防资料作回顾性分析 ,以探讨该方法在MS合并房颤 (Af)患者中的中远期疗效及其影响因素。方法 对 1992年 10月～ 2 0 0 0年 12月在我院行PBMV治疗的 60 0例MS患者的资料作回顾性研究 ,合并Af者 2 75例 (Ⅰ组 ) ,其余 3 2 5例为窦性心律者 (Ⅱ组 ) ,随防时间 3年～ 11年 ,平均 ( 5 .3± 3 .9)年。结果 Ⅰ组与Ⅱ组比较 ,中远期再狭窄率分别为 3 2 .3 %和 10 % ,需要药物治疗的心功能不全分别为 2 7%和 3 .6% ,死亡率分别为 1.8%和 0 .9% ,改行开胸换瓣或再次PBMV分别为 8.8%和 1.3 5 % ,脑栓塞分别为 2 .6%和 0 .45 %。结论 PBMV对MS合并Af患者的治疗中远期疗较窦性心律者差 ;总的并发症不高 ,疗效较好 。

Objective To explore the middle and long-term efficacy and influential factors of percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral stenosis (MS) and atrial fibrillation (Af).Methods The follow-up results of 600 MS patients with complete data of PBMV from October 1992 to December 2000 in our hospital were retrospectively analyzed.Among them,213 were females and 387 males,whose average ages were 41.3±7.3 (ranging from 16 to 66 ),275 patients with MS and Af (group I) and 325 patients with MS in sinus arrhythmia(group II) were treated.All cases were followed-up for 3 to 11 years(mean 5.3±3.9 ).Results Restenosis rate was 32.3% in group I and 10% in group II (P<0.001).The incidences of heart failure were 27% and 3.6% in group I and II (P<(0.001),)mortalities were 1.8% and 0.9% in group I and II (P<0.01).New mitral valve replacement surgery or repeated PBMV were performed in 8.8% and 1.35% patients in group I and group II (P<(0.01),)the rates of stroke were 2.6% and 0.45% in group I and group II (P<0.01).Conclusion The middle and long-term effect of PBMV in patients with MS and Af is less than that in patients with MS in sinus arrhythmia.However,incidence of complications of PBMV is lower.The prevention of complications and good clinical long-term efficacy depend on the choice of cases. \[