妊娠期经皮二尖瓣球囊扩张术的疗效分析

Clinical analysis of percutaneous balloon mitral valvuloplasty in pregnancy

目的探讨经皮二尖瓣球囊扩张术在妊娠期应用的效果。方法回顾性分析2000年1月至2020年12月广东省人民医院34例妊娠合并二尖瓣狭窄患者孕期进行经皮二尖瓣球囊扩张术的临床资料。结果孕妇年龄为(29.71±5.63)岁,孕周为(22.81±4.86)周,Wilkin′s评分为(7.08±0.83)分,其中孕中期手术者28例,孕晚期手术者6例;手术成功率97.06%(33/34),1例术后心力衰竭母胎死亡;其余围术期无胎儿丢失。手术前后二尖瓣口面积从(0.80±0.20)cm2增加至(1.59±0.31)cm2,左心房平均压从(32.25±10.07)mmHg(1 mmHg=0.133 kPa)降低至(18.79±7.73)mmHg,肺动脉收缩压从(77.21±28.20)mmHg降低至(50.06±28.41)mmHg,心功能Ⅰ级患者从0%增加至29.41%,心功能Ⅲ级患者从55.88%减少至11.76%,上述手术前后差异均有统计学意义(P<0.01)。结论妊娠合并二尖瓣狭窄患者孕期进行经皮二尖瓣球囊扩张术是安全有效的治疗方式。

Objectives To investigate the effect of percutaneous balloon mitral valvuloplasty in pregnancy.Methods Totally 34 pregnancy patients with mitral stenosis were retrospectively analyzed,who underwent percutaneous balloon mitral valvuloplasty in Guangdong Provincial People′s Hospital from January 2000 to December 2020.Results The mean age of these patients was(29.71±5.63)years.The mean gestational week was(22.81±4.86)weeks.The Wilkin′s score was 7.08±0.83.Among them,28 cases underwent percutaneous balloon mitral valvuloplasty in the second trimester,and 6 cases in late pregnancy.The procedures were successful in 33 patients(97.06%).Only one case died and fetal loss because of severe postoperative heart failure.Others had no fetal loss occurred during the perioperative period.Compared with the base line:the area of mitral valve area increased from(0.80±0.20)cm2 to(1.59±0.31)cm2,mean left atrial pressure decreased from(32.25±10.07)mmHg(1 mmHg=0.133kPa)to(18.79±7.73)mmHg,pulmo⁃nary artery systolic pressure decreased from(77.21±28.20)mmHg to(50.06±28.41)mmHg,the heart function gradeⅠpatients increased from 0%to 29.41%,and the heart function classⅢpatients decreased from 55.88%to 11.76%.The differences were statistically significant(P<0.01).Conclusions Percutaneous balloon mitral valvuloplasty during pregnancy is a safe and effective treatment method for patients with mitral stenosis.