经皮穿刺二尖瓣球囊成形术200例报告

PERCUTANEOUS TRANSSEPTAL BALLOON VALVULOPLASTY FOR TREATING MITRAL VALVE STENOSIS(REPORT OF 200 CASES)

本文对１９８８年５月至１９９２年７月间以Ｉｎｏｕｅ单球囊瓣膜成形术治疗二尖瓣狭窄２００例进行分析。本组中男６３例，女１３７例，平均年龄３６．５±８．８岁。经血液动力学及左室造影观察，取得良好效果。左房平均压自３．３４±１．２２ｋＰａ（２５．０８±９．１３ｍｍＨｇ）下降至１．４２±０．５５ｋＰａ（１０．６４±４．１０ｍｍＨｇ）（Ｐ＜０．００１）；二尖瓣跨瓣压差由３．４０±１．３６ｋＰａ（２５．４９±１０．２２ｍｍＨｇ）下降为０．８９±０．６５ｋＰａ（６．７１±４．８７ｍｍＨｇ），肺动脉收缩压由７．０４±２．８６ｋＰａ（５２．７８±２１．４２ｍｍＨｇ）下降为５．１４±２．２０ｋＰａ（３８．５６±１６．４７ｍｍＨｇ）（Ｐ＜０．００１）；心输出量由３．８４±０．１１Ｌ／ｍｉｎ上升为４．６６±０．２８Ｌ／ｍｉｎ（Ｐ＜０．００１）；二尖瓣口面积由１．０８±０．２８ｃｍ２增大为２．２０±０．４７ｃｍ２（Ｐ＜０．００１）。５０例随访６～４８个月（平均２４个月），临床症状改善率为１００％。本文对经皮穿刺二尖瓣球囊成形术（ＰＢＭＶ）适应证、方法、效果、并发症及其作用机制进行了讨论。

Two hundred cases (137 females, 63 males, aged 15～58 yrs, with an average of 36. 5±8. 8) with mitral valve stenosis were treated by percutaneous single Inoue Balloon valvuloplasty in this institute from May 1988 to July 1992. Hemodynamic and left ventriculographic findings were evaluated immediately before and after the procedure. The results showed that the mean left atrial pressure was reduced from 3. 34±1. 22to 1. 42±0. 55 kpa (p<0. 001), pressure gradient across the mitral valve from 3. 4±1. 36 to 0. 89±0. 65kpa (p<0. 001), and systolic pulmonary pressure from 7. 04±2. 86 to 5. 14±2. 20 kpa (p<0. 001). The cardiac output and mitral valve area were increased from 3. 84±0. 11 to 4. 66 ± 0. 28 L/min (p<0. 001) and 1. 08±0. 28 to 2. 20±0. 47 cm2 (p<0. 001), respectively. Follow-up for 6-48 months (median 24months) in 50 nonselective patients, the symptomatic improvement rate was 100%. The indications, method,effect, complications and mechanism of PBMV were discussed.