多普勒超声心动图引导二尖瓣狭窄球囊扩张的研究

Role of Doppler echocardiography in guidance of percutaneous balloon mitral valvuloplasty

目的 探讨经胸多普勒超声心动图在引导二尖瓣狭窄球囊扩张术中的作用。方法 以彩色、连续波及脉冲波多普勒技术引导球囊扩张术中逐渐递增球囊直径 ,结合二维超声心动图及X线 ,共同对 35例二尖瓣狭窄患者施行经皮穿刺二尖瓣球囊扩张术。结果 所有患者均取得满意扩张效果 ,无一例出现重度二尖瓣反流。二尖瓣跨瓣流速由 ( 2 .47± 0 .46 )m/s降至 ( 1.6 8± 0 .37)m/s (P <0 .0 0 1) ,跨瓣压差由 ( 2 5 .10± 9.6 0 )mmHg降至 ( 12 .2 7± 4.72 )mmHg (P <0 .0 0 1) ,瓣口面积从 ( 1.2 8± 0 .2 3)cm2 扩大至 ( 2 .2 3± 0 .31)cm2 (P <0 .0 0 1)。结论 应用多普勒超声心动图引导二尖瓣狭窄的球囊扩张既可达到充分扩张狭窄二尖瓣的目的 ,又可最大限度地避免和减少二尖瓣关闭不全的发生 。

Objective To explore the role of transthoracic Doppler echocardiography in the guidance of percutaneous balloon mitral valvuloplasty.Methods Under the guidance of color flow,pulsed wave and continues wave Doppler,35 patients with mitral stenosis received percutaneous balloon mitral valvuloplasty using stepwise method to increase the balloon size,assisted with 2-dimensional echocardiography and X-ray monitoring.Results All 35 patients showed satisfactory result without significant mitral regurgitation.Mitral inflow velocity decreased from ( 2.47± 0.46)m/s to ( 1.68± 0.37)m/s (P< 0.001), and the gradient from ( 25.10± 9.60)mm Hg to ( 12.27± 4.72)mm Hg (P< 0.001),mitral valve area was increased from ( 1.28± 0.23)cm 2 to ( 2.23± 0.31)cm 2 (P< 0.001).Conclusions It revealed that Doppler echocardiographic guidance could not only help to increase the mitral valve area during mitral valvuloplasty,but also prevent mitral insufficiency or decrease the incidence of severe mitral regurgitation compared with X-ray guidance alone.