经食管超声结合X线引导经皮二尖瓣球囊扩张术

Application of Transesophageal Echocardiography Combined with X-ray Fluoroscopy in Guiding Percutaneous Balloon Mitral Valvotomy

目的 :研究经食管超声 ( TEE)结合 X线实时引导经皮二尖瓣球囊扩张术 ( PBMV)的价值。方法 :对风湿性心脏病二尖瓣狭窄患者 4 3例 ,在食道四腔心平面观察 PBMV过程。结果 :TEE结合 X线 ,引导了全部患者的球囊扩张过程和 2 0例患者的穿刺房间隔过程。 19例房间隔穿刺一次成功 ,1例第二次穿刺成功。 TEE发现 4例患者左房钢丝一过性进入左心耳 ,及时撤出。 TEE显示 12例 18次球囊导管进入左心室过程中嵌入腱索 ,及时退出导管。 3例患者扩张后由二尖瓣轻度关闭不全转变为中度关闭不全 ,其余患者术后无二尖瓣关闭不全或程度无加重。无心包填塞 ,无继发性房间隔缺损及左向右分流者。结论 :PBMV术中运用 TEE引导有一定临床价值。

Objective:To evaluate the role of transesophageal echocardiography(TEE) combined with X ray fluoroscopy in guiding percutaneous balloon mitral valvotomy(PBMV).Methods:Forty three patients with rheumatic mitral stenosis underwent PBMV with intraoperative TEE monitoring on the four chamber view.Results:The transseptal puncture was successful done once in 19 patients and twice in 1 patients guided by TEE combined with X ray.TEE detected that left atrial guide wire entered left atrial appendage in 4 patients.TEE revealed that balloon catheters were embedded in chordae tendineae of mitral valve 18 times in 12 patients.Except 3 cases developing moderate mitral regurgitation from mild regurgitation,the other cases didn't develop mitral regurgitation or have mitral regurgitation worsened.Neither shunt from left atrium to right atrium nor cardiac tamponade was found.Conclusion:Combined with X ray fluoroscopy,TEE guiding is useful druing PBMV procedure.