摘要
Since 1991,we have performed PBMV on 35 mitral stenosis patients(pts).Clinical data:35 pts(10males,25 females)Mad 39.5(23-59)yrs,were diagnosed asmitral stenosis by ecbocardiogram.The course of disease was 9(1-39)yrs exceptactive stage of rheumatic fever.The mitral valve thiclmess was 4-8mm.TheMitral Valve Area(MVA)was 1.05(0.7-1.4)cm^2.The pts without atrial thronbusipcluded light aortic regurgitstion(AR)in3,light mitral regurgitation(MR)in5,atrial fibrillation in11I,NYHA cardiac function Ⅱ-Ⅲ°.Single-ballcontochniqus was applied on them,6 with Japan-amde balloon,29 with China-madebelloon.The balloon diameter was 2A-28mm.Besults:32 pts were successful in PBMV.Acute cardiac tamponade occurred toone case.The thoracotomy bemostasis and the mitral commissurotomy wereperformed in time.2 Cases failed in Interatrial septal punctura.Rapid atrialfibrillation occured to 1 cese.Aftor electrical conversion.sinus rhythmresumsed,and the operation accomplished.The symptom was obviously improvedin the successful 32 pts.Diastolic murisur in apical region of heart decreasedor disappeared.MVA increased 0.91cm^2(p【0.01).Left atrial pressure andtransmitral pressure gradient decreased 20 and 2.2 Kp(p【0.01).Conclusion:PSMV was successful in 5 pts with light MR and 3 pts with light ARSubjective symptom was improved and MR did not increase.So that PBMV iseffective in Mitral atenosis pts with light MR or light AR 11 atrialfibrillation pta(no atrial thrombus)without anticoagulant before PBMV bad noembolism.The results indicate that anticongulant before operation isusslesseful,but left atrial thrombus must be excluded under ecbocardiogram.The main complication in artial septum punturs is perforation of heart.Cardiac tampomads occurred to 1 case bucauss the cannula entered too deeplyand broke the left pulmonary veins.The followings should be done to decressethe perforation of heart:1)Before operation the anatomical position variationof atrial septum must be detected completely to clear the point of puncture.2)When the needle break the atrial septum,the cannula must be pushed afterthe needle is just in the left atrium.depending on the bemospasia,thecontrast examination and left atrial pressure determination.3) The canmulamay not be pushed too deeply to break the left atrium or the pulmonary veins.4) After taking out the needle,the contrast exnmination and left atrialpressure determination must be done again to decide the next step.
Since 1991,we have performed PBMV on 35 mitral stenosis patients(pts). Clinical data:35 pts(10males,25 females)Mad 39.5(23-59)yrs,were diagnosed as mitral stenosis by ecbocardiogram.The course of disease was 9(1-39)yrs except active stage of rheumatic fever.The mitral valve thiclmess was 4-8mm.The Mitral Valve Area(MVA)was 1.05(0.7-1.4)cm^2.The pts without atrial thronbus ipcluded light aortic regurgitstion(AR)in3,light mitral regurgitation(MR)in5, atrial fibrillation in11I,NYHA cardiac function Ⅱ-Ⅲ°.Single-ballcon tochniqus was applied on them,6 with Japan-amde balloon,29 with China-made belloon.The balloon diameter was 2A-28mm. Besults:32 pts were successful in PBMV.Acute cardiac tamponade occurred to one case.The thoracotomy bemostasis and the mitral commissurotomy were performed in time.2 Cases failed in Interatrial septal punctura.Rapid atrial fibrillation occured to 1 cese.Aftor electrical conversion.sinus rhythm resumsed,and the operation accomplished.The symptom was obviously improved in the successful 32 pts.Diastolic murisur in apical region of heart decreased or disappeared.MVA increased 0.91cm^2(p<0.01).Left atrial pressure and transmitral pressure gradient decreased 20 and 2.2 Kp(p<0.01). Conclusion:PSMV was successful in 5 pts with light MR and 3 pts with light AR Subjective symptom was improved and MR did not increase.So that PBMV is effective in Mitral atenosis pts with light MR or light AR 11 atrial fibrillation pta(no atrial thrombus)without anticoagulant before PBMV bad no embolism.The results indicate that anticongulant before operation is usslesseful,but left atrial thrombus must be excluded under ecbocardiogram. The main complication in artial septum punturs is perforation of heart. Cardiac tampomads occurred to 1 case bucauss the cannula entered too deeply and broke the left pulmonary veins.The followings should be done to decresse the perforation of heart:1)Before operation the anatomical position variation of atrial septum must be detected completely to clear the point of puncture. 2)When the needle break the atrial septum,the cannula must be pushed after the needle is just in the left atrium.depending on the bemospasia,the contrast examination and left atrial pressure determination.3) The canmula may not be pushed too deeply to break the left atrium or the pulmonary veins. 4) After taking out the needle,the contrast exnmination and left atrial pressure determination must be done again to decide the next step.
出处
《中国介入心脏病学杂志》
1998年第4期177-177,共1页
Chinese Journal of Interventional Cardiology
