妊娠期经皮二尖瓣球囊扩张术治疗中重度二尖瓣狭窄临床观察

Percutaneous balloon mitral valvuloplasty on pregnant women with moderate or severe mitral stenosis

目的探讨妊娠中晚期采用经皮二尖瓣球囊扩张术(percutaneous balloon mitral valvuloplasty,PBMV)治疗中重度二尖瓣狭窄的安全性和有效性。方法 15例妊娠合并中重度二尖瓣狭窄患者,均于妊娠中晚期行PBMV治疗。比较手术前、后患者二尖瓣口面积、心功能,记录妊娠结局。结果 15例患者手术过程均顺利;术后二尖瓣口面积[(1.91±0.23)cm2]较术前[(0.83±0.20)cm^2]明显扩大(P<0.05),术后心功能Ⅰ级4例,Ⅱ级11例;术后13例保持心功能Ⅰ~Ⅱ级者至足月终止妊娠,2例因心功能恶化实施医源性早产,新生儿发育正常;8例随访4~90个月,患者心功能保持在Ⅰ~Ⅱ级,子代生长发育无异常。结论在妊娠中晚期采用PBMV治疗中重度二尖瓣狭窄安全、有效。

Objective To evaluate the effectiveness and safety of percutaneous balloon mitral valvuloplasty(PMBV)in the treatment of pregnant women with moderate or severe mitral stenosis in the second and third trimester.Methods Fifteen pregnant women with moderate or severe mitral stenosis underwent PMBV in the second and third trimester and were compared the mitral valve area,cardiac function and pregnant results before and after operation.Results The procedure was successfully performed in all patients.The mitral valve area increased from(0.83±0.20)cm^2 before operation to(1.91±0.23)cm^2 after operation(P<0.05).The NYHA function was classⅠin 4patients and classⅡin11.Thirteen patients with NYHA classⅠ to Ⅱ had term delivery by caesarean section and the other two patients had preterm delivery by caesarean section for deteriorated NYHA function.All newborns had normal development.Eight patients were followed up for 4to 90 months,showing NYHA classⅠtoⅡ and normal growth and development of the children.Conclusion PMBV is safe and effective for moderate or severe mitral stenosis in pregnant women in the second and third trimester.