摘要
目的 评价经皮二尖瓣球囊形成术 (PBMV)对二尖瓣狭窄合并轻度主动脉瓣关闭不全患者的安全性和有效性。方法 对 6 8例二尖瓣狭窄合并轻度主动脉瓣关闭不全患者行PBMV ,术后随访 5年 ,平均随访时间 (5 4± 1 2 )年 ,内容包括心胸比率、超声心动图及心功能评价。结果 PBMV术前、术后一周二尖瓣口面积 (MVA)分别为 (1 16±0 30 )cm2 与 (2 2 1± 0 5 2 )cm2 ,术后MVA明显增加P <0 0 0 1;术后 5年MVA(2 0 7± 0 43)cm2 ,较术后一周MVA减少 ,仍比术前大 ,P <0 0 0 1;PBMV前、后左心室舒张末期内径为 (4 2 6± 0 5 0 )cm ,(4 5 8± 0 44 )cm ,术后 5年为 (4 85±0 47)cm2 ,术后及 5年随访与术前分别比较无显著性差异 ,P均大于 0 0 5 ;PBMV术前后及 5年随访主动脉瓣返流峰值压差分别为 (6 0 0 0± 35 5 4)mmHg ,(5 8 5 1± 38 71)mmHg ,(6 2 44± 34 6 7)mmHg ,术后一周及 5年与术前比较无显著性差异。术前后心胸比率分别为 (0 5 6± 0 0 6 )、(0 5 5± 0 0 5 )与(0 5 4± 0 0 6 ) ,术后心脏无显著扩大。PBMV术后心功能改善一个级别以上占 91 2 % ,能维持Ⅰ～Ⅱ级心功能 5年者占83 8% ,5年总生存率 98 5 %。 4例二尖瓣钙化 ,瓣下结构粘连纤维化严重的患者和 3例合并中重度三尖瓣关?
Objective To estimate effects and safety of PBMV operation on patients with mitral stenosis and mild aortic insufficiency Methods 68 patients suffered from mistral stenosis and mild aortic insufficiency undergo PBMV operation, regular post operation follow up for five years, average checkup time is (5 4± 1 2) years , contents were heart chest ratio, echocardiography and estimation of heart function Result Mistral Valve Area (MVA) before and one week after PBMV operation were respectively (1 16±0 30) cm 2 and ( 2 21± 0 52) cm 2, After operation MVA was increased significantly P >0 001; Post operation 5 years MVA was (2 07±0 43) cm 2 and comparatively smaller than MVA one week after operation; but was greater that prior to operation, P <0 001; The inner diameter of left ventricular diastole before and after operation were (4 26± 0 60) cm and (4 58±0 44) cm respectively Post operation and 5 years regular checkup separately compared with pre operation there was no significant difference Average value of P >0 05; peak value pressure difference pre, post PBMV operation and 5 years checkup on aortic regurgitation were (60 00±35 54) mmHg, (58 51±38 71) mmHg and (62 44±34 67) respectively, one week after operation and 5 years of checkup has no significant difference compared with before operation pre post operation heart chest ration were (0 56±0 06), (0 55±0 05) and (0 54±0 06) respectively, post operative heart shows no significant dilation After PBMV operation heart function would improve one stage occupy 91 2%, patients who could manage to control heart function between Ⅰ～Ⅱ stage for 5 years occuped 83 8%, the fatal life expectancy rate for 5 years were 98 5% 4 patients who suffered from sever mistral valve calcification Subvalvular adherence, fibrosis, and 3 patients in addition suffered from middle severe tricuspid valve insufficiency, replacement of valve or tricuspid ring shorten operation were carryout A young patient redeveloped mitral stenosis on the process of checkup earlier and conducted the PBMV operation for the second time, A patient with class IV heart function developed severe mitral regurgitation because PBMV , and that the valve was replaced, but he died from resuscitation heart failure at last Conclusion Patients who suffered from mitral stenosis coexisting with mild aortic insufficiency can be undergone PBMV , aortic regurgitation will not be increase after operation, also will not be enable left ventricular dilation, Severe valvular calcification, subvalvular adherence, fibrosis or coexisting with middle severe tricuspid value regurgitation, heart chest ration>0 60 are contrainolication of PBMV operation
出处
《岭南心血管病杂志》
2001年第3期190-192,共3页
South China Journal of Cardiovascular Diseases
