经皮二尖瓣球囊成形术治疗合并重度肺动脉高压的二尖瓣狭窄远期疗效评价

Long-term follow-up results of percutaneous balloon mitral valvuloplasty in mitral stenosis with severe pulmonary hypertension

目的 评价经皮二尖瓣球囊成形术 (PBMV)治疗合并重度肺动脉高压的二尖瓣狭窄 (MS)的远期疗效。方法 对 30例合并重度肺动脉高压的二尖瓣狭窄患者进行严格的PBMV术后随访 ,包括超声心动图、胸片 ,临床心功能评价。平均随访时间 (6 .4± 1.4 )年。结果 二尖瓣口面积 (MVA)由术前的 (1.19± 0 .32 )cm2 增至术后的 (1.99± 0 .4 5 )cm2 (P <0 .0 1) ;随访 5年以上 ,MVA逐渐减小至(1.4 4± 0 .4 2 )cm2 ,较术后明显减小 ,P <0 .0 1;16例发生再狭窄 ,再狭窄率 5 3.3%。平均肺动脉压(PAMP)由术前的 (6 5 .3± 14 .1)mmHg降至术后的 (40 .0 3± 12 .6 9)mmHg ,P <0 .0 1;PBMV术心功能改善 1个级别以上者占 93.3% ,术后 5年以上随访心功能仍维持在Ⅰ～Ⅱ级而未再次行介入或换瓣手术者占 73.3%。结论 PBMV术对合并重度肺动脉高压的MS患者也有较为满意的远期疗效 ,作为一种良好姑息疗法可明显缓解此类重症患者的临床症状。

Objective To assess long term results (more than 5 year) after percutaneous balloon mitral valruloplasty (PBMV) on mitral stenosis (MS) with severe pulmonary hypertension. Methods Thirty patients after PBMV underwent critical evaluations including echocardiography, chest film and clinical status throughout the follow up period (6.4±1.4 years). Results Before and after PBMV and at follow up, mean mitral valve areas were (1.19±0.32) cm 2 vs (1.99±0.45) cm 2 vs (1.44±0.42)cm 2 respectively ( P < 0.01 respectively). Restenosis rate was 53.3% at the end of follow up. There were twenty eight (93.3%) patients who obtained at least Ⅰ class (NYHA class) improvement in cardiac function shortly after PBMV. At the end of follow up, twenty two (73.3%) patients were still in class Ⅰ or Ⅱ without mitral reoperation or repeated valvuloplasty. Conclusions Long term follow up results after PBMV in mitral stenosis with severe pulmonary hypertension was satisfied, and PBMV can be an excellent therapy to improve the clinical status of such patients.