经皮球囊二尖瓣成形术426例及随访报告

EXPERIENCE OF 426 CASES AND FOLLOW-UP OF PERCUTANEOUS BALLON MITRAL VALVULOPLASTY

目的增加风心病二尖瓣狭窄瓣口面积。方法采用Inoue单球囊法对426例风心病二尖瓣狭窄患者行经皮球囊三尖瓣成形术（PBMV）治疗。结果左房平均压由术前（3．81±1．12）kPa降至术后（1．10±0．82）kPa（P＜0．001）；二尖瓣平均跨瓣压差由术前（2．68±0．58）kPa降玉术后（0．46±0．15）kPa（P＜0．001）；二尖瓣口面积由术前（0．96±0．15）cm2增大为术后（1．94±0．33）cm2（P＜0．001）。主要并发症：死亡2例，心脏穿孔5例，术中急性肺水肿8例，中、重度二尖瓣返流10例，脑梗塞2例。264例随访1～5年，258例症状明显改善。结论掌握好病例选择、房间隔穿刺技术及二尖瓣口的扩张是PBMV成功的关键。近、远期随访结果证实，PBMV是治疗风心病二尖瓣狭窄的有效方法。

Objective To increase the area of the mitral valve of the rheumatic heartdisease. Methods 426 cases of rheumatic mitral valve stenosis were treated by percutaneous bation mitral valvuloplasty (PBMV) with Inoue single bation in this hospital.Clinical observation,hemodynamics and two - dimensional echocardiogrophy were usedto evaluate the outcome. Results After valvuloplasty,the average pressure of the left atrium decreased from (3. 8l ±1. 12)kpa to (l. 10 ±0. 82)kpa (P <0. 001 ) ; the averagetransmural pressure of the mitral valve decreased from (2. 68 ±0. 58) kpa to (0. 46 ±0. 15)kpa (P <0. 001);the area of the mitral valve increased from (0. 96±0. 15)cm2 to(1. 94±0. 33)cm2. The main complications included: 2 cases of death, 5 cases of cardialperforation, 8 cases of acute pulmonery edema during operation, 10 cases of moderateand severe mitral regurgitation, 2 cases of cerebral infarction. The follow--up survey of264 cases for one to five years showed the clinical symptoms of 258 cases was obviouslyimproved. Conclusion it is an important guarantee to improve the success and decreasethe severe complications of PBMV if you select suitable cases,mastering the technique ofseptal puncture and the size of bation. Short --term and long--term follow--up of PBMVconfirmed that it is an effective methed of rheumatic mitral valve stenosis.