心脏直视下球囊扩张瓣膜的形态学观察

A morphological study of the valves during open heart balloon valvuloplasty

对２３例在体外循环下使用球囊导管进行直视肺动脉瓣或二尖瓣扩张病人的瓣膜形态学改变进行了观察。１４例先天性肺动脉瓣狭窄病人（１２例三叶瓣、２例二叶瓣）均为交界融合，瓣口面积为０．８～１．４ｃｍ２。扩张后至少有一个交界融合裂开，６例发生瓣撕裂，其发生撕裂与使用球囊径大小无相关。９例风湿性二尖瓣狭窄病人，扩张后８例前交界完全裂开，１例后交界完全裂开，前交界裂开较后交界明显。１例沿钙化斑边缘发生瓣撕裂。３例有瓣下粘连者，扩张效果不如其它６例。

Abstract The morphological changes of the valves in 23 patients who underwent open heart balloon pulmonary (n=14) and mitral (n=9) valvuloplasty were studied.Among 14 cases with congenital valvular pulmonary stenosis, 12 patients had a tricuspid valve and 2 had abicuspid valve. All of their valvular commissures were fused, and the pulmonary valve area (PVA) was 0.8-1.4cm2. With balloon pulmonary valvuloplasty (BPV), 6 cases had a leaflet rupture that each was independent of the diameter of dilated balloon. For 9patients with rheumatic mitral stenosis. 8 anterior and 1 posterior commissures were separated by balloon dilation. One leaflet rupture occured along calcific macula. A smaller mitral area and worse leaflet closure occured in 3 patients with subvalvular adhesion after balloon dilation.