重度二尖瓣狭窄球囊分离术42例分析

An analysis of 42 cases of percutaneous balloon derious mitral stenosis commissurotomy

目的 探索重度二尖瓣狭窄球囊分离术治疗的新方法.方法 房间隔穿刺点定位,采用吞钡食管左心房压迹定位法,以压迹上下缘的中下1/4水平线为房间隔穿刺高度,与脊柱中右1/4垂线的交点为房间隔穿刺点,穿刺成功率100%.穿刺成功后于右前斜位25°下行直接左心房造影,根据二尖瓣口位置调整二尖瓣探条(stylet),引导Inoue球囊过二尖瓣口,必要时在超声心动图指导下进左心室,选用直径23～28mm球囊扩张.结果 全部患者均成功,跨二尖瓣压差自18～51(34±11)mmHg降至4～9(7±3)mmHg(t=2.623,P<0.01).左心房平均压自20～60(38±13)mmHg,降至6～13(8±3)mmHg,二尖瓣听诊区雷鸣样舒张期杂音明显减轻或消失,效果显著(t=2.714,P<0.01).结论 对于风湿性心脏病重度二尖瓣狭窄,食管左心房压迹定房间隔穿刺点,安全而方便.右前斜位25°下,直接左心房造影显示二尖瓣口,指导Inoue球囊导管进左心室成功率高.

Objective To explore new method of percutaneous balloon serious mitral stenosis commissurotomy. Methods Locating puncture point on atrial septum by left atrial impression on esophagus, middle and lower 1/4 margin of the impression as highth of puncture, the crossing of the margin to middle and right 1/4 vertical line of spone is puncture point on atrial septum. Success rate of puncturing atrial septum is 100%. After success of the puncture, We use cardiography of left atrium to locate mitral orifice under RAO 25°. Inoue balloon catheter passes the orifice to left ventriculus with stylet, guided by ultracardiogram if necessary. Results Dilating mitral orifice with balloon of 23-28mm diameter is successful, gradient pressure decreasing to 4-9(7±3)mmHg from 18-51 (34±ll)mmHg(t=2. 623,P<0. 01), pressure of left atrium decreasing to 6-13(8±3)mmHg from 20-60(38±13)mmHg, the effect being effective(( = 2. 714,P<0. 01). Conclusion For RHD patients with serious mitral stenosis , locating puncture point on atrial septum with left atrial impression on esophagus is accurate, simple and easy to do. It is high successful rate that cardiography of left atrium locates mitral orifice and guides Inoue balloon catheter to left ventriculus in RAO 25°.