重度二尖瓣狭窄的球囊成形术方法学改良探讨

Modified Procedure of Percutaneous Balloon Mitral Valvuloplasty for Patients with Severe Mitral Stenosis

目的 旨在提高二尖瓣狭窄经皮二尖瓣球囊成形术 (PBMA)成功率。方法 采用自制二尖瓣导引钢丝操作球囊过瓣。结果30例重度二狭手术顺利成功 ,并发症少。二尖瓣面积由 0 .71 2± 0 .0 76cm2 扩大到 1 .60 1± 0 .2 72 (P <0 .0 1 ) ,左房平均压由 2 5 .2 0 0± 4 .930mmHg降至 1 3 .0 0 0± 4 .0 34(P <0 .0 1 ) ,二尖瓣最大跨瓣压差由 2 3 .433± 5 .0 0 8降至于 1 0 .60± 3 .42 0 (P <0 .0 1 ) ,左房内径由 48.2 33± 5 .51 9降至 43 .633± 5 .945mm(P <0 .0 1 ) ,心功能由Ⅳ级提高到Ⅲ级 1例 ,Ⅱ级 3例 ,由Ⅲ级提高到Ⅱ级 3例 ,Ⅰ级 1 8例 ,由Ⅱ级提高到Ⅰ级 5例。结论 此方法值得推广应用。

Objective To improve the success rate of Percutaneous Ballon Mitral Valvuloplasty (PBMV) for patients with severe mitral stenosis. Methods The balloon was led through the mitral valve with the wire made by ourselves. Results The operation of 30 patients of severe mitral stenosis is success. There was less complication. After operation, mitral valve area increased from 0.712 ±0.076cm 2 to 1.601 ±0.272 cm 2 (P<0.01), left atrial average pressure decreased from 25.200 ±4.930mmHg to 13.000 ±4.034 mmHg (P<0.01), the most mitral valve pressure decreased from 23.433±5.008mmHg to 10.60 ±3.420mmHg (P<0.01), left atrial diameter decreased from 48.233 ±5.519mm to 43.633 ±5.945mm (P<0.01). Cardiac function increased from Ⅳ to Ⅲ grade in one patient, from Ⅳ to Ⅱ in 3 patients, from Ⅲ to Ⅱ in 3 patients, from Ⅲ to Ⅰ in 18 patients, from Ⅱ to Ⅰ in 5patients. Conclusions This method is effective for patients with severe mitral stenosis, and it is worth popularizing.