再次经皮球囊二尖瓣成形术治疗成形术后再狭窄的疗效观察

Evaluation on results of repeat percutaneous balloon mitral valvuloplasty for mitral restenosis following prior balloon valvuloplasty

目的 评价再次经皮球囊二尖瓣成形术 (PBMV)治疗二尖瓣狭窄PBMV术后再狭窄的临床疗效。方法 采用Inoue法对 2 9例PBMV术后再狭窄患者进行再次PBMV ,并与 2 5 8例首次接受PBMV的患者进行疗效比较。结果 再次PBMV后二尖瓣口面积由 ( 0 98± 0 13)cm2 增至 ( 1 6 5±0 2 4)cm2 (P <0 0 0 1) ,二尖瓣跨瓣压差由 ( 2 6 5± 1 44 )kPa( 1kPa =7 5mmHg)降至 ( 0 79± 0 2 3)kPa(P<0 0 0 1) ,左房平均压由 ( 3 37± 0 6 2 )kPa降至 ( 1 6 6± 0 93)kPa(P <0 0 0 1) ,左房内径由 ( 4 5 2± 0 5 7)cm降至 ( 4 17± 0 5 0 )cm(P <0 0 5 )。再次PBMV组二尖瓣口面积增加值与左房平均压下降值小于首次PBMV组 [分别为 ( 0 6 7± 0 11)cm2 vs( 0 88± 0 32 )cm2 (P <0 0 5 )与 ( 1 71± 0 88)kPavs( 1 94± 0 5 6 )kPa(P <0 0 5 ) ]。再次PBMV组无心包填塞、死亡发生 ,主要并发症为重度二尖瓣反流 2例。结论只要选择合适病例 ,再次PBMV术仍可取得显著的即刻血流动力学改善 ,是PBMV术后再狭窄患者的一种安全而有效的治疗方法。

Objective To assess the results of repeat percutaneous balloon mitral valvuloplasty(PBMV) in patients with mitral restenosis after previous balloon valvuloplasty. Methods Twenty-nine patients with mitral restenosis following a successful first procedure underwent repeat PBMV with the Inoue technique, and were compared with 258 patients who received PBMV as an initial one.Results Repeat PBMV produced a significant increase in mitral valve area (MVA)from (0.98±0.13)cm2 to (1.65±0.24) cm2 (P<0.001), a decline in transmitral gradient from (2.65±1.44)kPa to (0.79±0.23)kPa(P<0.001), a reduction in mean left atrial pressure(LAP) from (3.37±0.62)kPa to (1.66±0.93)kPa(P<0.001) and in left atrial diameter from (4.52±0.57) cm to (4.17±0.50) cm (P<0.05). The mean increment in MVA and reduction in LAP in patients after repeat PBMV were less than those in whom PBMV was an initial procedure[(0.67±0.11) cm2 vs (0.88±0.32) cm2,(1.71±0.88)kPa vs (1.94±0.56)kPa, P<0.05, respectively].There was no cardiac tamponade or procedure-related death in repeat PBMV group. The major complication was severe mitral regurgitation in 2 patients. Conclusion Repeat PBMV after prior valvuloplasty yields excellent immediatle hemodynamic changes, which are comparable with patients with de novo mitral stenosis. Repeat PBMV is a safe and valid treatment for patients with post-PBMV mitral restenosis.