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目的:评价经皮二尖瓣球囊成形术治疗二尖瓣狭窄伴左房血栓形成的疗效、安全性。方法:56例伴有左房血栓形成患者术前经正规华法林抗凝治疗后,采用改良的房间隔定位法即“井”字定位法及运用跨二尖瓣技巧对二尖瓣狭窄伴左房血栓形成患者行逐步球囊扩张,以血流动力学评估手术前后即刻左房压、二尖瓣跨瓣压差及二尖瓣口面积,并进行手术后随访,观察有无体循环血栓栓塞等并发症。结果:与术前相比较,术后左心房平均压下降[(21.6±3.7)mmHg(1mmHg=0.133kPa)∶(35.1±4.2)mmHg]、二尖瓣跨瓣压差显著下降[(7.1±3.1)mmHg∶(16.8±4.5)mmHg)],二尖瓣口面积增大[(1.65±0.28)cm2∶(0.71±0.14)cm2],差异极有统计学意义(均P<0.01),心功能明显改善。超声心动图随访结果表明,经皮二尖瓣球囊成形术疗效稳定,无血栓栓塞并发症发生。结论:左房血栓形成仅为经皮二尖瓣球囊成形术的相对禁忌证,对于经充分华法林抗凝治疗的患者而言,经皮二尖瓣球囊成形术操作技术的改进能明显改善其症状,是安全有效的。
Objective: To evaluate the efficacy and safety of percutaneous balloon mitral valvuloplasty in the treatment of mitral stenosis with left atrial thrombosis. Methods: Fifty-six patients with left atrial thrombi were treated with formal warfarin before anticoagulation. A modified atrial septal localization method was used to locate the mitral stenosis with mitral valve stenosis Patients with left atrial thrombosis underwent progressive balloon dilatation. The left atrial pressure, mitral valve pressure and mitral orifice area immediately before and after surgery were assessed by hemodynamics. The patients were followed up after surgery to observe whether there was systemic thromboembolism Other complications. Results: Compared with the preoperative, the average left ventricular pressure decreased ([(21.6 ± 3.7) mmHg (1mmHg = 0.133kPa): (35.1 ± 4.2) mmHg] 3.1) mmHg: (16.8 ± 4.5) mmHg), the mitral valve area increased (1.65 ± 0.28) cm2:(0.71 ± 0.14) cm2, the difference was statistically significant (all P <0.01) Function significantly improved. Echocardiographic follow-up results showed that percutaneous balloon mitral valvuloplasty was effective and no thromboembolic complications occurred. Conclusions: Left atrial thrombosis is only a relative contraindication to percutaneous balloon mitral valvuloplasty, and improvements in the technique of percutaneous balloon mitral valvuloplasty are significantly improved for patients treated with warfarin adequately Its symptoms are safe and effective.