论文部分内容阅读
目的:评价经皮球囊二尖瓣成形术(PBMV)治疗风湿性心脏病(风心病)重度二尖瓣狭窄(MS)合并巨大左心房的可行性、安全性和有效性。方法:风心病重度MS合并巨大左心房患者共28例,其中男9例,女19例,年龄20～51(34.9±7.5)岁。采用常规及改良的非常规方法进行PBMV。以手术前后肺动脉平均压、左房平均压、二尖瓣跨瓣压差及左心房直径、二尖瓣口面积等血流动力学指标评估PBMV效果,并观察有无体循环血栓栓塞等并发症。结果:PBMV成功率为100%。与术前相比较,术后肺动脉平均压下降[(42.28±7.58)mmHg(1mmHg=0.133kPa)∶(23.17±5.99)mmHg]、左心房平均压下降[(28.11±6.18)mmHg∶(13.11±4.43)mmHg]、二尖瓣跨瓣压差显著下降[(19.55±6.14)mmHg∶(7.87±3.01)mmHg)],差异均具有统计学意义(P<0.001);同时左心房直径明显减小[(68.61±8.92)cm∶(51.39±7.88)cm]、二尖瓣口面积增大[(0.75±0.17)cm2∶(1.87±0.33)cm2],差异亦均具有统计学意义(P<0.01),心功能明显改善。无血栓栓塞并发症发生。结论:对于合并巨大左心房的风心病重度MS进行PBMV是安全有效的。
OBJECTIVE: To evaluate the feasibility, safety and efficacy of percutaneous balloon mitral valvuloplasty (PBMV) for the treatment of severe mitral stenosis (MS) with giant left atrium in rheumatic heart disease (rheumatic heart disease). Methods: A total of 28 patients with severe rheumatic heart disease (MS) complicated with large left atrium were enrolled. Among them, 9 were males and 19 were females, ranging in age from 20 to 51 (34.9 ± 7.5) years. PBMV was conducted using conventional and modified unconventional methods. Preoperative and postoperative average pulmonary artery pressure, left atrial average pressure, transvalvular mitral valve pressure and left atrial diameter, mitral orifice area and other hemodynamic indicators to assess the effect of PBMV, and to observe the complications such as systemic thromboembolism. Results: The success rate of PBMV was 100%. Compared with that before operation, mean pulmonary artery pressure decreased [(42.28 ± 7.58) mmHg (23.17 ± 5.99) mmHg] and mean left atrial pressure decreased [(28.11 ± 6.18) mmHg:(13.11 ± 4.43) mmHg], and the mitral valve pressure decreased significantly ([(19.55 ± 6.14) mmHg: (7.87 ± 3.01) mmHg)], with statistical significance (P <0.001) (68.61 ± 8.92) cm: (51.39 ± 7.88) cm, and mitral valve area increased (0.75 ± 0.17) cm 2 (1.87 ± 0.33) cm 2 (P <0.01) ), Heart function improved significantly. No thromboembolic complications occur. Conclusions: PBMV is safe and effective for patients with severe rheumatic heart disease with left atrium.