经皮二尖瓣球囊扩张术致房间隔缺损的探讨

Effect of percutaneous balloon mitral valvuloplasty on the atrial septum

目的评价经皮二尖瓣球囊扩张术（PBMV）对房间隔的影响。方法对32例风湿性心脏病二尖瓣狭窄行PBMV的患者，分别于手术前、手术后行经胸心脏彩超（TTE）检查，术后即刻右心导管取全套血测血氧饱和度。术后3个月及以后每年一次TTE复查。结果32例PBMV全部成功，术前未发现有房间隔缺损（ASD），而术后并发ASD6例，发生率为18．8％。TTE检查ASD的直径为5．5~8．8mm，其中4例ASD位置偏高（在卵圆窝的上方），1例ASD位置偏低。6例ASD患者的上腔静脉与右心房血氧饱和度差均大于9％以上。追踪观察：其中3例3至12月后ASD消失，2例ASD直径缩小，1例未复查。结论PBMV会导致一部分的ASD，但缺口分流小，在二尖瓣狭窄扩开左房压降低的情况下，不会引起血流动力学改变，随时间推移ASD可自行愈合或缩小。要降低ASD的发生率，需选择适当的房间隔穿刺点和正确的操作手法。

Objective To evaluate the influence of percutaneous balloon mitral valvulo-plasty (PBMV) on atrial septum. Method Performing color echocardiography through thoraciccavity and heart (TTE) before and after PBMV for 32 patients with rheumatic mitral stenosis andmeasuring immediately oxygen saturation of the blood taken through right cardiac catheter afterPBMV. Three months after PBMV and then every year the patients were reexamined with TTE.Results All of 32 patients have no atrial septal defect (ASD) before the operaion and the oper-ation was successful, however, there was 6 cases to have developed ASD after the operation, being18. 8%. TTE showed the diameter of the defect ranging from 5. 5 mm to 8. 8 mm. The Postion ofthe defect in 4 cases was slightly high, locatingt above fossa ovalis, and in one case slightly low.The difference of oxygen saturation of blood between superior vena cava and right cardiac atriumin 6 cases with ASD was over 9%. The follow - up showed that ASD in 3 patients disappeared af-ter 3 to 12 months, in 2 cases has reduced and one case was not reexamined. Conclusion PB-MV can cause ASD in some of the patients on dilating the mitral stenosis for reducing the pressurein the left atrium, but the shunt volume of the defect is so little that the change in hemodynamicsis not obvious, and the ASD can close or reduce spontaneously later. To reduce the incidence rateof ASD, it is important to position suitable puncture point on atrial septun and to operate correctly.[