二尖瓣狭窄伴轻度反流患者经皮二尖瓣球囊扩张术及远期疗效观察

Evaluation on short-term and long-term clinical results after percutaneous balloon mitral valvuloplasty in 41 patients with mitral valve stenosis and mild mitral valve regurgitation

目的:探讨伴轻度反流(MR) 的二尖瓣狭窄(MS)患者经皮二尖瓣球囊扩张术(PBMV)术后及长期疗效.方法:采用改良Inoue方法,自1993年5月～2001年12月对MS合并轻度MR的41例患者行PBMV治疗,并进行超声心动图和临床心功能评价.结果:二尖瓣口面积(MVA)由(1.15±0.25) cm2 增至(1.88±0.32) cm2 ( P<0.001 );二尖瓣跨瓣压差(MVG)由(19.3±5.2) mmHg 降至(7.6±3.2) mmHg (P<0.001 );左心房内径(LAD)由(4.78±0.63) cm 减小到(4.21±0.48) cm (P<0.001 );心功能由(2.56±0.50) 级改善至(1.54±0.60) 级(P<0.001 ) ; 左室内径(LVD)无明显变化(P>0.05 ), 22例二尖瓣反流减轻或消失,15例二尖瓣反流维持不变,4例二尖瓣反流加重,无患者行急诊或择期二尖瓣置换术.41例患者随访时间9～112个月,平均(90±24)个月,MVA、MVG、MLAP、LAD、LVD和心功能与术后比较,均无明显变化(P>0.05) ,1例于术后15个月时死亡,4例再狭窄,再狭窄率为9.76%.结论:选择好病例,把握球囊扩张尺度,风湿性心脏病二尖瓣狭窄伴轻度反流患者PBMV 近、远期疗效好.

Objective Evaluation on short-term and long-term clinical results after percutaneous balloon mitral valvuloplasty(PBMV) in patients with mitral valve stenosis (MS) and mild mitral valve regurgitation (MR). Methods From May 1993 to December 2001, forty-one patients with MS and mild MR were performed PBMV with the improved Inoue way, echocardiography was done initially and within long-term follow-up period. Results Successful rate of PBMV was 100 %. The mean mitral valve area was (1.15±0.25) cm 2 before PBMV vs (1.88±0.32)cm 2 after PBMV immediately vs (1.79±0.45 )cm 2 during follow-up,mean mitral valve gradient was (19.3±5.2)mmHg vs (7.6±3.2 )mmHg vs (8.1±4.1 )mmHg, respectively,mean left atrial diameter were (4.78±0.63)cm vs (4.21±0.48)cm vs (4.25±0.52)cm, respectively,mean cardiac function (NYHA) was (2.56±0.50) vs (1.54±0.60) vs (1.59±0.63), respectively. The regurgitation in 22 cases disappeared or became more mild after the procedure. 4 cases become more sever. 41 cases were followed up for (90±24) months. There are no significantly difference comparing with that after the procedure in the mean mitral valve areas, mean mitral valve gradient, mean left atrial diameter and mean cardiac function(P>0.05 ). One patient died after 15 monthes post PBMV. There were 4 patients with restenosis and restenosis rate was 9.76% during follow-up. Conclusion The satisfied result of PBMV in MS with mild MR is depended on the selection of patients and the optimal dilatation of the valve.