经皮二尖瓣球囊成形术在二尖瓣狭窄伴重度心力衰竭时的应用

Percutaneous balloon mitral valveoplasty in patients with mitral valve stenosis and serious heart failure

介绍二尖瓣狭窄伴重度心力衰竭（心衰）患者实施经皮二尖瓣球囊成形术（PBMV）的结果和初步体会。9例患者中男6例，女3例，年龄24～52岁，全部患者心功能均为Ⅳ级（按NYHA分级），术前抗心衰药物治疗效果极不理想。经施行PBMV后，血流动力学明显得已改善：左房平均压由术前4．34±1．02kPa（1kPa=7．5mmHg）降至术后1．64±0．82kPa，二尖瓣跨瓣压差由术前3．26±0．84kPa降至术后0．72±0．56kPa；瓣口面积由术前0．78±0．30cm^2增至术后2．11±0．24cm^2，左房内径术后较术前缩小了约10mm（P值均＜0．001）；在短期内心功能迅速恢复至Ⅰ～Ⅱ级，运动耐量明显增加，心衰症状缓解率达100％。作者认为：二尖瓣狭窄伴重度心衰时，只要排除了加重心衰的其他原因，应尽早施行PBMV，PBMV是一种安全、可靠和行之有效的治疗方法。作者同时对PBMV时球囊方式选择及并发症的防治进行了讨论。

Percutaneous balloon mitral valveoplasty (PBMV)was performed in 9 patients (6 males, 3 females,average39. 6 years)with mintral valve stenosis and seriousheart failure, All patients with mitral valve stenosishad grade Ⅳ heart function. Anti - heart failure therapywas not satisfactory. After PBMV, hemodynamicswas greatly improved. The left atrial pressure reducedfrom 4. 34 ± 1. 02kPa to 1. 64 ± 0. 82kPa, the mitralvalve transvalve pressure reduced from 3. 26±0. 84kPato 0. 72 ± 0. 56kPa, the area of mitral valve enlargedfrom 0. 78±0.30cm^2 to 2.11±0. 24cm^2, and the diameterof left atrial reduced by about 10mm(P<0.001)after PBMV. Heart function of these patients recoveredto grade Ⅰ - Ⅱ,exercise tolerence was improved significantly,symptoms of heart failure in all patients werereleased.