开展经皮二尖瓣球囊成形术的经验和体会

PBMV: Experience in passing through the learning carve

采用Ｉｎｏｕｅ法对５０例风心二尖瓣狭窄（ＭＳ）患者施行经皮二尖瓣球囊成形术（ＰＢＭＶ）治疗。单纯ＭＳ者１４例，伴二尖瓣返流（ＭＲ，１－２／４度）及轻度主动脉瓣病变３６例。房颤２１例，外科闭式分离术后再狭窄４例，术后血液动力学显著改善：左房平均压从２３．７±７．７降至１１．０±４．９ｍｍＨｇ（Ｐ＜０．００１），跨二尖瓣压差（ＭＶＰＧ）由２０．２±８．３降至４．１±３．２ｍｍＨｇ（Ｐ＜０．００１）。二尖瓣瓣口面积从０．９１±０．２０扩大到２．０３±０．２ｃｍ２（Ｐ＜０．００１），左房径从４．９６±０．８２缩小至４．１±０．５１ｃｍ（Ｐ＜０．０１），主功能从３±０．４６提高到１．３７±０．５１（Ｐ＜０．００１）。本组病例无１例发生严重并发症。掌握好房间隔穿刺技术，选择无明显瓣膜钙化和瓣下严重融合的病例，对房颤病人进行抗凝准备和正确掌握扩张终点是ＰＢＭＶ成功和减少严重并发症的重要保证。

The operation of percutaneous balloon mitral valvuloplasty (PBMV) was performed with inoue balloon on 50 patients with rhumatic mitral stenosis (MS). Excepting the MS for this patients. 19 cases had a mild mitral regurgition and 17 cases had a mild damage of aortic valve. 2l cases had atrial fibrillation. 4 patients had a previous surgcal mitral valve commissurotomy. The changes of mitral morphology were comparatively analysed by echocardiography before and 3～7 days after PBMV. Most patients had a significante improvement of hemodynamics after the procedure :the left atrial pressure was decreased from 23. 71±7. 68 to 11. 01±4. 89 mmHg (P<0. 001).transmitral pressure gradient was decreased form 20.17±8. 32 to 4. 14±3. 19 mmHg(P<0. 001), mitral valve area (MVA) was increased from 0. 91±0. 20 to 2. 03±0. 24cm2 (P<0. 001), and left atrial diameter (LAD) was reduced from 4. 96± 0. 82 to 4. 12± 0.51cm(P<0. 01). Cardiac fuction (NYHA) was raised from 3. 00±0. 46 to 1. 37±0. 51 (P0. 001). Onecase with large atrium (LAD) = 8. 2cm) and severe MS (MVA = 0. 52cm2) had unsuccessful procedure, in whom the mitral valve could not be crossed. Other 49cases succed. There were no sever complications,such as cardiac tamponade, severe MR. embolism or significant left-to-right shunt. For patients with mild MR and mild damage of aortic valve, PBMV can alose be performed on them. A marked improvement in procedural success and complication rates is attributable to refinement of patient selection criterion,technical advances in the procedure, and operator expericence. The results demonstrate that PBMV is a safe and reliable procedure in the treatment of rheumatic mitral stenosis.