经皮球囊导管二尖瓣成形术治疗风湿性二尖瓣狭窄的长期随访观察

Long-term follow up of percutaneous balloon mitral valvuloplasty in patients with rheumatic mitral stenosis

目的 评价经皮球囊导管二尖瓣成形术 (PBMV)治疗风湿性二尖瓣狭窄 (MS)的远期疗效。方法 自 1989年 5月至 1997年 12月对风湿性MS 336例患者采用Inoue法行PBMV。对成功的330例进行 8年的随访 ,每年随访 1次 ,根据临床症状、心尖部舒张期杂音及第一心音的强度改变、心功能、二维及多普勒超声心动图检测的二尖瓣口面积判断远期疗效。随访时二尖瓣口面积比PBMV后增加的面积缩小 5 0 %以上为再狭窄。结果 5 2例再狭窄 ,再狭窄率 16 % ,其中 44例 (85 % )发生于PBMV 5年后 ,术前二尖瓣面积小以及术后扩张欠充分可能是再狭窄的一个因素。 10例再狭窄者再次行PBMV成功 ,4例因症状加重置换瓣膜。 6例术后发生二尖瓣关闭不全 ,其中 3例心功能仍改善 ,另 3例接受瓣膜置换术。医源性房间隔缺损 7例 ,术后杂音减轻。 1例PBMV 1年后脑梗塞 ,残留轻度偏瘫。结论 PBMV治疗风湿性MS具有良好的远期疗效 ,对于再狭窄者只要具备适应证 ,仍有望再次PBMV成功。

Objective To evaluate the long term effect of percutaneous balloon mitral valvuloplasty (PBMV) in patients with rheumatic mitral stenosis (MS). Methods From May 1989 to December 1997 PBMV was performed with Inoue technique in 336 patients, and follow up with a duration of 8 years was done in 330 successful cases once a year. Long term effect after PBMV was evaluated according to clinical symptoms, cardiac function, change of diastolic murmur in apex and loudness of first sound, and two dimmensional and Doppler echocardiography. Results Restenosis occurred in 52 cases totally with a restenosis rate of 16%, among them 44 cases (85%) developed restenosis in 5 years. Small mitral orifice area (MVA) before and less dilatation of MVA after PBMV may be the factors related to restenosis. Ten cases of restenosis underwent PBMV once again successfully. Mitral valvular replacement (MVR) was performed in 4 patients due to decrease of cardiac function. Mitral regurgitation occurred in 6 patients after PBMV, 3 of them also underwent MVR. The cardiac murmur of iatrogenic atrial septal defect in 7 cases decreased during the follow up. Conclusion The PBMV for treatment of rheumatic MS has a good long term clinical effect. Patients with restenosis still have hope to receive PBMV once again as long as they have indications of PBMV.