二尖瓣球囊扩张术治疗二尖瓣狭窄伴轻度、重度肺动脉高压的近期疗效

The short-term therapeutic effects of percutaneous balloon mitral valvoplasty on patients with mitral stenosis complicated with severe or mild pulmonary arterial hypertension

目的 比较经皮二尖瓣球囊扩张术 (PBMV)治疗二尖瓣狭窄伴严重肺动脉高压 (肺动脉收缩压≥ 80mmHg ,Ⅰ组 )和对照组 (二尖瓣狭窄伴肺动脉收缩压 <5 0mmHg ,Ⅱ组 )的近期效果。方法 PBMV均采用改良Inoue单球囊技术。结果 两组PBMV手术成功率和严重并发症相似 ,术后Ⅰ组MVA≥ 1.5cm2 者为5 5 .6 % ,和Ⅱ组 (6 7.8% )相似。两组术后肺动脉压力明显下降 ,2 4h和 48h肺动脉压力进一步下降 ,但Ⅰ组仍未降至正常。术后两组的纽约心脏协会 (NYHA)心功能相似 ,但从改善心功能讲 ,Ⅰ组心功能明显改善者高于Ⅱ组 (86 .1%和 42 .4% ) ,术后两组心功能恶化者均较少。结论 PBMV治疗二尖瓣狭窄伴严重肺动脉高压是安全有效的 ,可明显改善心功能 ,减轻肺动脉压力。

Objective To study the near term therapeutic effects of percutaneous balloon mitral valvotomy (PBMV) on patients with mitral stenosis complicated with pulmonary arterial hypertension. Methods Inoue single balloon technique of PBMV was used to treat patients with mitral stenosis complicated with severe pulmonary arterial hypertension (systolic pressure of the pulmonary artery was higher than 80 mmHg, group Ⅰ) and control group with mild pulmonary arterial hypertension (systolic pressure of the pulmonary artery was lower than 50 mmHg, group Ⅱ). Results The successful rate of PBMV and the incidence of severe complications were similar in the 2 groups. After PBMV, MVA in 55.6% of cases in group Ⅰ and 67.8% in group Ⅱ was larger than MVA>1.5 cm 2. After PBMV, the systolic pressure of the pulmonary artery was significantly reduced in the 2 groups and further reduced 24 to 48 hours after PBMV but pulmonary arterial pressure remained higher than the normal in group Ⅰ. NYHA was similar in the 2 groups. Cardiac functions were improved in 86.1% in group Ⅰ and 42.4% in group Ⅱ. Worsening of cardiac functions was rarely encounted. Conclusion PBMV is a safe and efficient technique to treat patients with mitral stenosis complicated with pulmonary arterial hypertension in that it can improve cardiac functions and reduce pulmonary hypertension.