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目的:探讨二尖瓣球囊扩张术(PBMV)治疗风湿性心脏病二尖瓣狭窄合并三尖瓣反流患者疗效和安全性。方法:选择60例二尖瓣狭窄合并三尖瓣反流患者,以76%泛影葡胺17ml递增法扩张,每次增加0.5～1ml,扩张终点使左心房压下降50%以上,或左心房平均压达到15mmHg以下,二尖瓣区舒张期隆隆样杂音消失或明显减轻。结果:60例患者经PBMV后二尖瓣口面积(1.6±0.3)cm2,较术前(0.9±0.3)cm2显著增加(P<0.01);术后三尖瓣反流面积(6.2±4.0)cm2,较术前(10.3±6.4)cm2显著减少(P<0.01);术后左心房直径(45.4±7.4)mm,较术前(49.7±7.9)mm显著减小(P<0.01),术后右心房直径(28.7±5.6)mm,较术前(46.5±6.3)mm显著减小(P<0.01),术后左心房平均压(15.6±6.1)mmHg(1mmHg=0.133kPa)较术前(25.5±6.6)mmHg显著减小(P<0.01),术后右心房压力(13.2±2.4)mmHg较术前(18.5±4.7)mmHg显著下降(P<0.01);二尖瓣区舒张期隆隆样杂音从中重度减为轻度,收缩期吹风样杂音从术前0～1/6级升高到1～2/6级,胸闷气促症状明显缓解,即术前可登楼2～4层即感觉胸闷气促,术后可以登4～7层,随访2个月～9年,无并发症的发生。结论:PBMV治疗风湿性心脏病二尖瓣中重度狭窄合并三尖瓣轻中度反流患者,可以减轻症状,减轻三尖瓣返流面积,改善生活质量,近中期疗效确切,安全性好。
Objective: To investigate the efficacy and safety of mitral valve balloon mitral valvuloplasty (PBMV) in patients with rheumatic mitral stenosis and tricuspid regurgitation. Methods: Sixty patients with mitral stenosis and tricuspid regurgitation were treated with 76% diatrizoate 17ml increment method, 0.5 ~ 1ml each time. The left atrial pressure was decreased more than 50% Mean pressure reached 15mmHg below the mitral valve area diastolic rumbling disappeared or significantly reduced. Results: The mitral valve area in 60 patients after PBMV was (1.6 ± 0.3) cm2, significantly higher than that before operation (0.9 ± 0.3) cm2 (P <0.01) (P <0.01). The left atrium diameter (45.4 ± 7.4) mm after operation was significantly lower than that before operation (49.7 ± 7.9) mm (P <0.01) The mean diameter of the left atrium was (28.7 ± 5.6) mm, significantly lower than that of the preoperative (46.5 ± 6.3) mm (P <0.01). The mean left atrial pressure (15.6 ± 6.1) mmHg (25.5 ± 6.6) mmHg (P <0.01), postoperative right atrial pressure (13.2 ± 2.4) mmHg decreased significantly compared with preoperative (18.5 ± 4.7) mmHg (P <0.01) From the moderate to severe noise reduced to moderate, systolic hair-like noise from 0 to 1/6 before surgery to 1 to 2/6 level, chest tightness, shortness of breath significantly relieved symptoms, that is, before ascension 2 to 4 layers that Chest tightness, shortness of breath, postoperative can be boarded 4 to 7, followed up for 2 months to 9 years, no complications. Conclusion: PBMV treatment of patients with moderate to severe mitral stenosis complicated with mild to moderate tricuspid regurgitation in rheumatic heart disease can relieve the symptoms, relieve the tricuspid regurgitation area and improve the quality of life.