一站式经皮二尖瓣球囊成形术联合射频消融治疗风湿性二尖瓣狭窄合并持续性心房颤动的临床效果

Clinical efficacy of one-stop percutaneous balloon mitral valvuloplasty combined with radiofrequency ablation in the treatment of rheumatic mitral stenosis with persistent atrial fibrillation

目的:探讨一站式经皮二尖瓣球囊成形术联合射频消融治疗风湿性二尖瓣狭窄合并持续性心房颤动(房颤)的临床安全性及疗效。方法:39例中重度风湿性二尖瓣狭窄合并持续性房颤患者分为A组20例,B组19例。两组均行经皮二尖瓣球囊成形术。B组术后即刻复查心脏彩超,二尖瓣瓣口面积大于1.5 cm2且无心包积液及中度以上二尖瓣反流,立即行房颤射频消融术。比较B组术前及术后6个月左心房内径、二尖瓣瓣口面积、NT-proBNP、6 min步行试验距离等,并记录围手术期并发症及术后房颤复发情况。比较两组术后6个月左心房内径、二尖瓣瓣口面积、NT-proBNP、6 min步行试验距离。结果:B组术后有2例患者出现少量心包积液,给予观察后自行吸收;随访过程中有1例患者于术后1个月复查时再次出现房颤,心脏彩超提示瓣口面积减少至1.0 cm2,并再发心力衰竭,至心外科行二尖瓣置换术;2例于术后3个月复发房颤,应用胺碘酮后转复窦性心律。B组患者术后6个月时左房内径、二尖瓣瓣口面积、NT-proBNP、6 min步行试验距离改善优于A组(P<0.05)。结论:一站式经皮二尖瓣球囊成形术联合射频消融治疗二尖瓣狭窄合并持续性房颤安全、有效。

Aim:To investigate the clinical safety and efficacy of one-stop percutaneous balloon mitral valvuloplasty combined with radiofrequency ablation in the treatment of rheumatic mitral stenosis with persistent atrial fibrillation.Methods:A total of 39 patients with moderate to severe rheumatic mitral stenosis complicated with persistent atrial fibrillation were allocated into group A(n=20)and group B(n=19).Percutaneous balloon mitral valvuloplasty was performed in both groups.In the group B,immediately after the operation,the echocardiography was rechecked,the patients with mitral valve area greater than 1.5 cm2 but without pericardial effusion or moderate mitral regurgitation were immediately treated with atrial fibrillation radiofrequency ablation.In the group B,the left atrial diameter,mitral valve area,NT-proBNP,and 6-minute walk test distance were compared before and 6 months after the operation,and perioperative complications and postoperative recurrence of atrial fibrillation were recorded.The left atrial diameter,mitral valve area,NT-proBNP,and 6-minute walk test distance were also compared between the two groups 6 months after the operation.Results:In the group B,a small amount of pericardial effusion occurred in 2 patients during operation,which was absorbed during observation.During the follow-up,1 patient developed atrial fibrillation again at the reexamination one month later,the echocardiography suggested that the mitral valve area was reduced to 1.0 cm2,and the patient had recurrent heart failure and accepted mitral valve replacement.Two patients with recurrent atrial fibrillation 3 months after the operation were converted to sinus rhythm by using amiodarone.In the group B,the left atrial diameter,mitral valve area,NT-proBNP,and 6-minute walk test distance 6 months after the operation were improved compared with those before operation,which were also better than those in the group A(P<0.05).Conclusion:One-stop percutaneous balloon mitral valvuloplasty combined with radiofrequency ablation is safe and effective in the treatment of rheumatic mitral stenosis with persistent atrial fibrillation.