心房颤动伴左房血栓患者的经皮二尖瓣球囊扩张术

Percutaneous balloon mitral valvuloplasy in patients with atrial fibrilation and left atrial thrombus

目的评价经皮二尖瓣球囊扩张术(PBMV)治疗心房颤动(AF)伴左房血栓的二尖瓣狭窄患者的临床疗效。方法选具备PBMV指征的风湿性二尖瓣狭窄(MS)合并心房颤动患者10例,经食管超声心动图(TEE)证实存在左房内血栓,均为2000年4月以后的住院患者,均予华法林治疗2个月后进行PBMV。扩张前后测左房压力,术后1周内复查TTE,观察左房内径(LAD)、二尖瓣口面积(MVA)、二尖瓣跨瓣压力阶差(MVPG)、二尖瓣前后交界裂开及二尖瓣反流等改变。结果经华法林抗凝治疗2个月后复查TEE发现,左房内血栓消失或机化。PBMV术后左房平均压(MLAP)及MVPG均较术前明显降低(P<0.001),而LAD在1周内缩小明显(P<0.01),术后二尖瓣反流(MR)增加不明显。术后均有二尖瓣交界裂开,其中前交界裂开6例,后交界裂开4例,前后交界均裂开3例,UCG检查显示MVA较前明显增加(P<0.001)。结论 AF伴左房血栓的PBMV在经华法林治疗2个月后仍然可行和安全,且在血流动力学参数、瓣口面积等方面均可达到较满意疗效。

Objective To evaluate the therapeutic effect of percutaneous balloon mitral valvuloplasy（PBMV） in patients with atrial fibrilation and left atrial thrombus.Methods 10 patients（9 women and 1 men,average age 45.5±2.1 years old） with left atrial thrombus founded by Transesophageal echocardiography（TEE） were observed.All cases received warfarin for more than 2 months before undergoing PBMV,to observe whether systematic thromboembolisrn occured during the PBMV operation.The parameters of hemodynamics and cardiac function of 10 patients were measured.Results The procedural success rate was l00%,no systemic thromoembolisrn occurred during and after PBMV.The parameters of hemodynamics and cardiac function were improved markedly.Conclusion PBMV on patients with with atrial fibrilation and left atrial thrombus is safe,effective,feasible after sufficient anticoagulation treatment.