经皮球囊二尖瓣成形术成功患者10年以上远期随访

Long term outcome of successful percutaneous balloon mitral valvuloplasty

目的观察经皮球囊二尖瓣成形术(PBMV)后10年以上的远期疗效。方法对271例成功行PBMV的患者进行跟踪随访,包括症状、体征、NYHA心功能分级、心电图和二维及多普勒超声心动图。结果随访10.2~19.5(14.3±1.3)年,随访结束时二尖瓣瓣口面积(MVA)与术后相比显著缩小[(1.4±0.2)cm^2比(2.0±0.2)cm^2,P<0.05],但仍明显大于术前[(1.4±0.2)cm^2比(1.0±0.2)em^2,P<0.01];随访平均二尖瓣跨瓣压差(MVG)及肺动脉收缩压(SPAP)较术前显著下降[MVG:(12.3±5.3)mmHg比(17.2±5.3)mmHg,P<0.01;SPAP:(46.4±12.2)mmHg比(57.9±13.1)mmHg,P<0.01,1 mmHg=0.133 kPa],较术后升高[MVG:(12.3±5.3)mmHg比(9.2±4.2)mmHg,P<0.05;SPAP:[(46.4±12.2)mmHg比(29.5±10.2)mmHg,P<0.05];随访NYHA心功能分级仍然维持Ⅰ~Ⅱ级患者193例(71.8%);130例(48.0%)患者发生再次狭窄;9例(3.3%)患者死亡;无事件生存率为81.2%。结论PBMV术后>10年临床远期疗效良好。

Objective To investigate the long term outcome（above ten years） of successful Percutaneous Balloon Mitral Valvuloplasty.Methods From April 1996 to April 1999,271 patients with rheumatic mitral value stenosis who underwent successful PBMV in our hospital were followed up for above ten years.All patients were followed up for clinical signs and symptoms,NYHA classification,ECG and echocardiography.Results Follow-up study was carried out for 10.2- 19.5 years（mean 14.3 ±1.3 years）.The mean mitral valve areas（MVA） at follow up were significantly smaller than post-operation area[（1.4 ± 0.2） cm vs.（2.0 ± 0.2） cm,P〈0.05]but were larger than pre-operation area[（1.4±0.2） cm vs.（1.0±0.2） cm,P0.01].The transmural gradient and the systolic pulmonary artery pressure at follow up were significantly lower than before operation[MVG：（12.3 ±5.3） mmHg vs.（17.2 ±5.3） mmHg,P0.01;SPAP：（46.4±12.2） mmHg vs.（57.9 ±13.1） mmHg,P0.01],but higher than post operation[MVG：（12.3 ±5.3） mmHg vs.（9.2 ±4.2） mmHg;SPAP：（46.4 ±12.2） mmHg vs.（29.5 ±10.2） mmHg,all P0.05].The rate of restenosis was 48.0%and mortality rate was 3.3%.The event-free survival rate was 81.2%.During follow up,the percentage of patients remained in New York Heart Association classes Ⅰ or Ⅱ was 71.8%.Conclusions PBMV shows good long-term results（above ten years） in most patients.