风湿性二尖瓣狭窄(RMS)合并肺高压(PH)经皮球囊二尖瓣成形术(PBMV)的短期疗效

Short-term outcomes of percutaneous balloon mitral valvuloplasty (PBMV) in patients with rheumatic mitral stenosis (RMS) complicated with pulmonary hypertension (PH)

目的评价经皮球囊二尖瓣成形术(percutaneous balloon mitral valvuloplasty,PBMV)对风湿性二尖瓣狭窄(rheumatic mitral stenosis,RMS)合并肺高压(pulmonary hypertension,PH)患者的短期疗效。方法回顾性连续纳入于2015年1月至2018年12月在复旦大学附属中山医院心内科住院接受PBMV治疗的患者,并根据PBMV术前所测得的肺动脉平均压(pulmonary artery mean pressure,PAMP)将患者分为两组:PH组(PAMP≥25mmHg)和非PH组(PAMP<25mmHg),采用右心导管经胸/经食道超声心动图测量的各项指标进行评价。结果共纳入157例患者。术后两组患者的二尖瓣瓣口面积(mitral valve area,MVA)、左心房内径(left atrial diameter,LAD)、PAMP、左房平均压(left atrial mean pressure,LAMP)、肺动脉收缩压(pulmonary artery systolic pressure,PASP)均有显著性改善(P<0.05),其中PAMP降至正常或接近正常水平。PH组患者PAMP、LAMP、PASP的下降幅度显著大于非PH组患者(P<0.05),但PH组患者术后MVA仍小于非PH组,LAD、PAMP、LAMP、PASP仍高于非PH组(P均<0.05)。结论无论术前肺动脉压是否正常,PBMV可有效降低RMS患者的肺动脉压,短期疗效较好;应在肺动脉压升高之前行PBMV,从而预防肺血管不可逆的改变。

Objective To investigate the short-term outcomes of percutaneous balloon mitral valvuloplasty (PBMV) in patients with rheumatic mitral stenosis (RMS) complicated with pulmonary hypertension (PH). Methods Patients who received PBMV from Jan.,2015 to Dec.,2018 in the Department of Cardiology,Zhongshan Hospital,Fudan University were consecutively and retrospectively analyzed.Then they were divided into two groups with pre-operative pulmonary artery mean pressure (PAMP)≥25 mmHg and PAMP<25 mmHg,respectively.Pre- and post-operative cardiac catheterization,transthoracic and transesophageal echocardiography were used to evaluate the short-term outcomes of PBMV in the two groups. Results A total of 157 patients were enrolled mitral valve area (MVA),left atrial diameter (LAD),PAMP,left atrial mean pressure (LAMP) and pulmonary artery systolic pressure (PASP) of the two groups were all significantly improved after PBMV ( P <0.05),and PAMP could be reduced to normal or near normal level.The decrease of PAMP,LAMP and PASP in the group with PAMP≥25 mmHg was significantly greater than those in the other group ( P <0.05).However,the MVA were still smaller ( P <0.05) and the LAD,PAMP,LAMP,PASP were still higher ( P < 0.05 ) in the group with PAMP≥25 mmHg than those in the other group. Conclusions PBMV can effectively reduce the pulmonary artery pressure in patients with RMS,and its short term outcomes is well whether the preoperative pulmonary artery pressure is normal or not.However,PBMV should be performed before the increase of pulmonary artery pressure to prevent the irreversible change of pulmonary vessels.