利用多普勒超声对二尖瓣球囊扩张术后肺动脉高压预后的随访评价

Effect of Percutaneous Balloon Mitral Valvuloplasty on Pulmonary Hypertension inPatients with Mitral Stenosis:A Follow-Up Evaluation by Doppler

目的 :评价经皮二尖瓣球囊扩张术 (PBMV)对二尖瓣狭窄合并肺动脉高压患者的近、中、远期疗效。方法 :对 2 6例术前、术后、随访中均存在经超声证实的三尖瓣反流 ,同时合并肺动脉高压的二尖瓣狭窄患者 ,利用多普勒超声估测其肺动脉收缩压 (PASP)值 ,并进行随访评价 ,随访时间 1～ 10 6 (平均 3 5± 1 5 )年。结果 :2 6例患者PASP估测值由术前的 6 5 6 6± 19 5 0mmHg ( 1mmHg =0 133kPa)降至术后即时的 43 85±11 97mmHg ,近、中、远期随访估测值分别为 41 81± 8 2 6mmHg、 41 77± 9 30mmHg和 44 0 4± 10 0 5mmHg ,均较术前有显著下降 ,有非常显著性差异 (P <0 0 1) ,较术后即时值无明显差异 (P >0 0 5 ) ,但远期随访估测值较中期有显著意义的升高 (P <0 0 1)。结论 :PBMV对二尖瓣狭窄合并肺动脉高压患者有较好的近、中期疗效 ,其远期疗效尚不确定 ,还有待进一步研究。

Objective:To assess the short,mid,and long-term effects of percutaneous balloon mitral valvuloplasty (PBMV)on pulmonary hypertension (PH)in patients with mitral stenosis. Methods:Twenty-six patients with mitral stenosis complicated by pulmonary hypertension and tricuspid regurgitation (TR)were studied.Systolic pulmonary artery pressure (PASP) of the patients was evaluated by Doppler using the modified Bemoulli equation.A long term follow-up study for an average period of 3.5±1.5(range 1 to 10.6)years was carried out. Results:The values of PASP in 26 patients estimated by Doppler decreased from 65.66±19.50mmHg (pre-valvuloplasty)to 43.85±11.97 mmHg (post-valvuloplasty).Similarly,the values in the follow-up examinations also decreased,but they were elevated in the long-term follow-up period significantly,compared with those in the mid-term period (p<0.05). Conclusion:Short-and mid-term follow-up results demonstrate that PBMV has good effect on pulmonary hypertension due to mitral stenosis,The long-term effect remains concertain and need to be further studied.