部分联合瓣膜病患者经皮球囊二尖瓣成形术远期疗效观察

摘要

Objective: To observe the long-term effect of percutaneous balloon mitral valvuloplasty(PBMV) in patients of rheumatic mitral valve stenosis combined with mild mitral incompetence and/or mild aortic valve vitium.Methods:A total of 126 patients of mitral valve stenosis combined with mild mitral incompetence and/or mild aortic valve vitiun received the improved Inoue technique,a type of PBMV operation,and the mitral valve was dilated step by step during the operation. 110 patients were followed-up for the average of 36 ～ 118(78±31 )months.Results:The operational success rate was 96.0％ (121/126). After PBMV,the patient's left atrial mean pressure,left atrial diameter,area of mitral valve orifice,mitral valve gradient and pulmonary artery systolic pressure were all improved,P＜0.05 respectively. There was no significant difference between short-term and long-term effect after the operation,P＞0.05. Long-term follow-up presented that the clinical symptoms,cardiac function and the quality of life were significantly improved in most patients.Conclusion:PBMV is safe and effective for patients of mitral valve stenosis combined with mild mitral incompetence and/or mild aortic valve vitium. It is important to have the proper operative indication and adequate pire-operative management.%目的:观察部分风湿性心脏病二尖瓣狭窄合并轻度关闭不全或(和)轻度主动脉瓣病变患者经皮球囊二尖瓣成形术(PBMV)的远期疗效.方法:126例二尖瓣狭窄合并轻度关闭不全或(和)轻度主动脉瓣病变的患者,全部采用改良Inoue法行PBMV,术中采用逐步递增扩张法扩张二尖瓣,术后进行远期随访.结果:126例患者PBMV成功121例(成功率为96.0%).术后110例患者完成了远期随访,平均随访78±31(36～118)个月.术后近期和远期随访期间患者左心房平均压、左心房内径、二尖瓣瓣口面积、跨瓣压差及肺动脉收缩压均较术前明显改善,差异均有统计学意义(P均＜0.05),且远期随访结果与近期随访结果均相似,差异均无统计学意义(P>0.05).远期随访期间,大多数患者临床症状、心功能及生活质量亦明显改善.结论:对于部分二尖瓣狭窄合并轻度关闭不全或(和)轻度主动脉瓣病变的患者,只要合理选择适应证,恰当而谨慎地进行围手术期的各项工作,亦可安全地施行PBMV,其近期和远期疗效皆佳.