经皮球囊二尖瓣成形术治疗846例风心病患者的疗效与体会

Effects and experiences of percutaneous balloon mitral valvuloplasty in 846 patients with rheumatic mitral stenosis

目的 报道经皮球囊二失瓣成形术（PBMV）治疗846例风湿性二尖瓣狭窄（MS）患者的疗效与体会。方法 通过时接受PBMV治疗的846例MS患者资料进行回顾性分析，比较PBMV前后心脏杂音、NYHA心功能级别、二尖瓣返流（MR）程度、血动力学资料及二尖瓣口面积（MVA）的变化。结果 846例中的843例完成了PBMV治疗。PBMV后，平均肺动脉压从（58±26）mmHg（1mmHg=0．133kPa）下降至（32±14）mmHg（P〈0．001）、平均左心房压由（42±11）mmHg下降至（13±5）mmHg（P〈0．001）、平均二尖瓣跨瓣压差（MVG）由（32±8）ramHg下降至（9±4）mmHg（P〈0．001）；MVA（n=768）由（0．96±0．32）cm^2增加至（1．99±0．42）cm^2（P〈0．001）；心排量从（4．3±1．2）L／min增加至（5．5±1．5）L／min（P〈0．05），心指数从2．7±1．6增加至3．6±1．9（P〈0．005），左心室射血分数由（47．9±10．2）％上升至（66．2±8．9）％（P〈0.01）。PBMV后，826例（98％）症状显著改善，绝大多数患者的心杂音消失或减轻，NYHA心功能级别显著改善。重要并发症包括：急性心包填塞9例、Ⅰ～Ⅱ度MR10例、原有Ⅰ～Ⅱ度MR程度不同地加重者9例、脑血栓栓塞1例、感染性休克1例。结论 PBMV治疗MS是安全有效的；采用球囊直径递增法扩张并监测MVG、监听心杂音变化能有效预防严重MR的发生；正确的房间隔穿刺技术是预防心包填塞的关键。

Objective To evaluate the effects and experiences of percutaneous balloon mitral valvuloplasty （PBMV） in 846 patients with rheumatic mitral stenosis. Methods Of 846 consecutive patients, 813 patients successfully underwent PBMV. Cardiac murmur, stage of NYHA class, hemodynamic data, cardiac output （CO）, and degree of mitral regurgitation （MR） echocardiography were measured before and after PBMV. Results After PBMV, the mean pulmonary artery pressure decreased from （58± 26）mm Hg to （32±14）mm Hg （P〈0. 001）, the mean left atrial pressure decreased from （42±11）mm Hg to （13±5）mm Hg （P 〈0. 001）, the mean mitral valve gradient decreased from （325=8）mm Hg to （9±4）mm Hg （P〈0.001）, the mitral valve area （n =768） determined by echocardiography increased from （0. 965±0.32） to （1.99± 0. 42）cm^2 （P〈0. 001）, with an increase in CO from （4.35±1.2） to （5.55±1.5）L/min （P〈0.05）, LVEF from （47.95±10.2） % to （66.25±8.9） % respectively. Symptoms were improved in 826 （98 %） of 843 patients. Cardiac murmurs were vanished or alleviated, NYHA class of cardiac function was significantly improved, and the MR degree of post-PBMV had not a significant change in most of patients. Mild MR in 10 patients （1. 2%） and severe MR in 9 patients （1.9%） developed, increased by one grade in 9 patients（1.1%）, and decreased by one or two grades in 16 patients. The other important complications included acute pericardial tamponade in 9 cases, brain arterial thromboembolism and infection shock in 1 case respectively. Conclusions （1）PBMV is effective therapy for patients with MS; （2）It is useful for preventing the occurrence of severe MR that using a stepwise dilatation technique and monitoring the changes of mitral valve gradient and cardiac murmur during PBMV procedure; （3）Proficient atrium septal puncture technique is key for preventing the occurrence of pericardial tamponade.