经皮二尖瓣球囊导管成形术136例分析

分析自1990年12月至1997年2月的74个月实施经皮二尖瓣球囊导管成形术(PBMV)136例，前24m为A组，在国产500mAX光机下施术34例．成功29例(853%)，失败5例(14．7%)，其中严重并发症3例(8．8％)。后50m为B组，在进廿DSA下用改进方法施术102例，成功98倒(96．08%)，失败3例(2．9%)，严重并发症1例(0．98%)。改进法的特点为(1)#域定位加手感定点，持续压力监测，随时“冒烟”。(2)以负压球囊和新月形路径法入严重狭窄的二尖瓣口。(3)往复球囊导管使稍膨起的前囊浮动，避免球囊嵌入致腱索断裂造成返流。(4)递增球囊直径法分次扩张，防止过度扩张造成交界外撕裂。分析认为，经验积累和方法的改进提高了成功率，降低了失败串和并发症发生率，改善设备的图象质量，有助于提高成功率。     

经皮二尖瓣狭窄球囊扩张432例临床研究

目的：为能提高经皮二尖瓣球囊导管成形术(PBMV)的成功率、扩大适应症范围，减少术中并发症。方法：采用Inoue法．创用“井”阈划区加手感定点法穿刺房间隔，球囊导管以后C和4字路径及负压球囊入二尖瓣口，递增球囊直径分次扩张的手法进行操作。结果：在施术的432例中成功420例(97．22％)。并发心包填塞4例(0．93％)，失败4例，中止4例。结论：认为在具备影象和外科保障条件下。帮带中重视自身体验。感悟总结手法技巧是顺利开展PBMV的关键，待技术熟练后稳妥放宽适应症。改善图象质量有助于提高成功率，减少并发症。     

经皮二尖瓣狭窄球囊扩张432例临床研究

目的：为能提高经皮二尖瓣球囊导管成形术(PBMV)的成功率、扩大适应症范围，减少术中并发症。方法：采用Inoue法，创用“#”阈划区加手感定点法穿刺房间隔，球囊导管以后C和4字路径及负压球囊入二尖瓣口，递增球囊直径分次扩张的手法进行操作。结果：在施术的432例中成功420例(97．22％)，并发心包填塞4例(0．93％)，失败4例，中止4例。结论：认为在具备影像和外科保障条件下，帮带中重视自身体验，感悟总结手法技巧是顺利开展PBMV的关键，待技术熟练后稳妥放宽适应证，改善图像质量有助于提高成功率，减少并发症。     

经皮球囊二尖瓣成形术严重并发症的护理

经皮球囊二尖瓣成形术(PBMV)由于创伤小,恢复快,成功率高等优点,已经成为治疗单纯二尖瓣狭窄的首选措施。但据资料分析各种并发症的总发生率为9．1％,其中严重并发症的发生率为3．7％,最常见的严重并发症有急性心包填塞和重度二尖瓣返流(MR)。我院自1993年以来,共施行PBMV97例,成功93例,失败5例,     

经皮二尖瓣球囊扩张术后心房颤动即刻电复律的探讨

目的 :探讨风湿性心脏病二尖瓣狭窄伴心房颤动 (AF)的患者经皮二尖瓣球囊扩张术 (PBMV )术前口服胺碘酮结合术后即刻电复律的安全性及应用价值。方法 :采用Inoue单球囊扩张风心病二狭伴AF3 8例 ,PBMV术后即刻给予 10 0～ 3 0 0J电复律 ,术后随访 3个月。结果 :本组PBMV术后即刻电复律成功率高 ( 92 11%) ,无严重心律失常及栓塞并发症。口服胺碘酮维持窦性心律有效率 ( 88 5 7%)。结论 :PBMV术后心房颤动即刻电复律不仅安全可行 ,而且效果满意     

PBMV的器械准备及清洗消毒方法

经皮球囊二尖瓣成形术（PBMV）由日本外科医生Inoue首创．所用的Inoue气囊导管由他本人设计．气羹由两层橡胶夹一层尼龙网做成，充盈顺序为末端一近端一中间三步。PBMy是通过机械的球运膨胀力作用于粘连的辩膜，使粘连的江膜沿粘连线分离．增加二尖瓣口面积．降低舒张末期二尖瓣压力阶差．而无并发症出现，达到治疗风心病二尖瓣狭窄的目的。近来．我们为13例病人进行了PBMV．其中男4例．女9例．年龄22～53岁．平均年龄38．5岁．二失瓣辨口面积0．8～1．scm’．除三例22岁女性患者术后效果不明显外．其余疗效均满意。现将PBMV的器械准…     

经皮二尖瓣球囊成形术在二尖瓣狭窄伴重度心力衰竭时的应用

介绍二尖瓣狭窄伴重度心力衰竭（心衰）患者实施经皮二尖瓣球囊成形术（PBMV）的结果和初步体会。9例患者中男6例，女3例，年龄24～52岁，全部患者心功能均为Ⅳ级（按NYHA分级），术前抗心衰药物治疗效果极不理想。经施行PBMV后，血流动力学明显得已改善：左房平均压由术前4．34±1．02kPa（1kPa=7．5mmHg）降至术后1．64±0．82kPa，二尖瓣跨瓣压差由术前3．26±0．84kPa降至术后0．72±0．56kPa；瓣口面积由术前0．78±0．30cm~2增至术后2．11±0．24cm~2，左房内径术后较术前缩小了约10mm（P值均＜0．001）；在短期内心功能迅速恢复至Ⅰ～Ⅱ级，运动耐量明显增加，心衰症状缓解率达100％。作者认为：二尖瓣狭窄伴重度心衰时，只要排除了加重心衰的其他原因，应尽早施行PBMV，PBMV是一种安全、可靠和行之有效的治疗方法。作者同时对PBMV时球囊方式选择及并发症的防治进行了讨论。     

经皮二尖瓣球囊扩张术治疗重度二尖瓣狭窄疗效分析

目的 探讨经皮二尖瓣球囊扩张术(PBMV)治疗重度二尖瓣狭窄的疗效及安全性.方法 采用改良的房间隔定位法对56例重度二尖瓣狭窄患者行逐步球囊扩张.结果 PBMV有效扩大二尖瓣口面积,与术前比较,术后左心房压下降[(2.36±0.41)kPa比(3.92 ±0.75)kPa]、二尖瓣跨瓣压差显著下降[(2.13±0.74)kPa比(3.71±1.54)kPa],左心房内径减小[(43.7±6.1)mm比(50.2±5.6)mm]、二尖辩口面积扩大[(1.65±0.31)cm2比(0.61±0.12)cm2],差异均有统计学意义(P均＜0.01),心功能显著改善.结论 PBMV治疗重度二尖瓣狭窄是安全有效的.     

国产ZQ型腔静脉支架治疗布-加综合征下腔静脉病变的疗效观察

目的 探讨国产ZQ型腔静脉支架(ZQS)治疗布加综合征(BCS)下腔静脉病变的临床疗效。方法 161例BCS下腔静脉病变，在闭塞开通术及球囊扩张术的基础上，置人国产ZQS。结果 161例共置人ZQS165枚。其中置人3节ZQS者153例(含4例置入2枚3节ZSQ者)，置人2节ZQS者6例，置人4节ZQS者1例。ZQS置人成功者157例，成功率为97．5％。失败者4例，占2．5％。失败原因为支架位置不正或／和展开不良。与支架置人相关的并发症1例，为支架置人后急性血栓形成。随访3～60个月(平均28．9月)，6例出现再狭窄。结论 国产ZQ型腔静脉支架治疗BCS下腔静脉病变安全、有效，可以替代同类进口产品。     

经皮二尖瓣球囊成形术(附22例报告)

本文报导22例经皮二尖瓣球囊成形术（PBMV），均获成功。左心房压从术前2．87±1．06降至术后1．20±0．49KPa（P＜0．001），二尖瓣辩跨瓣压差从2．8±0．71降至0．71±0．11KPa（P＜0．001）。二尖瓣瓣口面积自1．08±0．38增至2．11±0．40cm2（P＜0．001）。PBMV创伤小且安全，厅发局，故用于二尖瓣狭窄非手术治疗，深受患者欢迎。     

The advantages of On-line transesophageal echocardiography guide during percutaneous balloon mitral valvuloplasty.

The purpose of this study was to evaluate the potential advantages of on-line transesophageal echocardiography during percutaneous balloon mitral valvuloplasty (PBMV). One hundred thirty-four consecutive patients who underwent PBMV were included in this study. Group 1 included 64 patients who underwent PBMV under fluoroscopy guide only, and group 2 included 70 patients who underwent PBMV under on-line transesophageal echocardiography guide. Inoue balloons were used in all cases. The mitral valve area after valvuloplasty was comparable between the 2 groups. The procedure time was significantly shorter in group 2 (99 +/- 48 min vs 64 +/- 22 min, P <.0001 ), and the average fluoroscopy time was shorter in group 2 without statistical significance (30 +/- 17 min vs 19 +/- 15 min, P =.25 ). Five (7.8%) patients in group 1 and 2 (2.8%) patients in group 2 underwent surgery because of procedure-related complications. The limitation of this study was the learning curve of the operator, because the 2 groups were treated serially. In conclusion, transesophageal echocardiography can be used effectively during balloon mitral valvuloplasty, and it may help to reduce the rate of complications resulting from trans-septal catheterization and balloon valvuloplasty and to reduce procedure time and fluoroscopy time.     

经皮球囊二尖瓣成形术对风湿性心脏病二尖瓣狭窄伴阵发性房颤患者P波离散度的影响

目的　探讨经皮球囊二尖瓣成形术 (PBMV)对风湿性心脏病二尖瓣狭窄伴阵发性房颤患者P波离散度的影响。方法　风湿性心脏病二尖瓣狭窄患者 90例。依据患者是否伴阵发性房颤分为两组。不伴阵发性房颤 (A组 ) 6 0例 ,伴阵发性房颤 (B组 ) 30例 ,均接受PBMV术 ,分别测量两组患者术前及术后 3个月P波最大时限 (Pmax)和P波离散度 (Pd)。结果　术前B组患者Pmax及Pd显著高于A组 (P <0 .0 1) ,术后 3个月B组患者Pmax及Pd较术前显著减低 (P <0 .0 1)。结论　Pmax及Pd可预测风湿性心脏病二尖瓣狭窄患者伴阵发性房颤的发生 ;PBMV术可改善心房电传导。降低风湿性心脏病二尖瓣狭窄伴阵发性房颤患者的Pmax及Pd。     

Efficacy of percutaneous mitral balloon valvuloplasty with the inoue balloon

Percutaneous mitral balloon valvuloplasty has become an accepted technique for use in selected patients with severe, symptomatic mitral stenosis. Recently, a new balloon catheter with an "hourglass" shape and specially designed guidewires and dilators has become available (Inoue balloon). The design of this balloon provides ease of manipulation and self-stabilization across the mitral valve during inflation. These features should decrease the incidence of complications associated with the procedure. Preliminary results in 12 consecutive patients who underwent percutaneous mitral balloon valvuloplasty with the Inoue balloon are presented. The mitral valve area increased from 0.92 +/- 0.21 cm2 before the procedure to 1.75 +/- 0.40 cm2 after the procedure. No complications occurred from the procedure, including no increase in severity of mitral regurgitation or creation of an atrial septal defect. Further follow-up is necessary to determine the long-term efficacy with this new balloon. Nonetheless, the preliminary results are encouraging.     

二尖瓣球囊成形术前后心电图PtfV1的改变及意义

目的：研究风湿性心脏病（风心病）二尖瓣狭窄患者二尖瓣球囊成形术（ＰＢＭＶ）前后心电图ＰｔｆＶ１的改变及其与血流动力学、二维超声心动图的相关性。方法：测定２４例风心病患者ＰＢＭＶ前后心电图ＰｔｆＶ１、血流动力学和二维超声心动图参数并作相关分析。结果：ＰｔｆＶ１术后较术前明显降低（Ｐ＝０．０１３），手术前后ＰｔｆＶ１与血流动力学及二维超声心动图参数均无明显相关性。结论：心电图ＰｔｆＶ１可作为术后血流动力学改善的无创性指标之一，ＰｔｆＶ１在风心病二尖瓣狭窄中的异常可能是多种因素共同影响所致     

超声心动图对急症诊断经皮二尖瓣球囊扩张术瓣叶穿孔的价值

本文分析5例风湿性心脏病重度二尖瓣狭窄患者，经皮二尖瓣球囊扩张术（PBMV）后，瓣叶穿孔的超声心动图（UCG）特异性表现为：原狭窄的二尖瓣口无改变，而瓣叶（多见前叶）回声连续中断，彩色多普勒显示（CDFI）收缩期大量蓝色为主返流束经撕裂穿孔瓣叶入左房，此表现为急症诊断PBMV穿孔提供了明确可靠的依据。     

实时超声心动图引导二尖瓣狭窄球囊扩张术的研究

应用实时超声心动图引导二尖瓣狭窄球囊扩张术的研究，表明超声心动图可术中引导穿刺房间隔及球囊通过狭窄的二尖瓣口、观察二尖瓣交界区裂开的形态，并提示术者是否需增加球囊直径再次扩张以达到充分扩张二尖瓣、巩固疗效的目的。此外，还可降低手术并发症。     

Transesophageal echocardiography during percutaneous balloon mitral valvuloplasty

To ascertain the value of transesophageal echocardiography during percutaneous balloon mitral valvuloplasty, the present study was undertaken in 26 anesthesized patients (21 women and 5 men; mean age, 47 years) with symptomatic rheumatic mitral valve stenosis. In all but one patient the balloon dilation of the mitral valve was successful and Doppler-derived valve area increased (0.9 +/- 0.3 to 1.9 +/- 0.4 cm2). Transesophageal echocardiography provides continuous monitoring, as well as guidance of the procedure. Crossing the arterial septum, as well as delivery of the sheath through the mitral valve orifice and correct positioning of the balloon, was highly facilitated and reduced x-ray exposure time. The degree of mitral regurgitation and the presence of interatrial shunting at the end of the procedure could be readily assessed, making cineangiography not necessary. Complications of the procedure, such as pericardial effusion, could be detected before hemodynamic deterioration had occurred (one patient). The advantages of transesophageal echocardiography for routine monitoring of percutaneous mitral valvuloplasty, however, should be weighted against the added risk and expense of this support.     

风湿性心脏病左房室瓣狭窄介入治疗疗效评价

目的　评价经皮左房室瓣球囊成形术治疗左房室瓣狭窄的疗效。方法　穿刺股静脉 ,送入Mullins导管 ,以Brockenbrough穿刺针穿刺房间隔 ,送入左房导丝 ,通过输送器沿导丝送入Inoue球囊扩张左房室瓣。结果　 7例患者左房室瓣口面积平均 0 96± 0 19cm2 ,术后左房室瓣口面积 2 14± 0 2 0cm2 (P <0 0 5 ) ;左房平均压、肺动脉平均压明显下降 (P <0 0 5 ) ,心功能明显提高。随访临床症状持续改善。结论　PBMV治疗左房室瓣狭窄安全、疗效确切     

Pulmonary vascular resistance and proper timing of percutaneous balloon mitral valvotomy

It is frequent to see pulmonary hypertension (PH) in patients with mitral stenosis (MS) secondary to increased pulmonary vascular resistance (PVR), data about the effect of PVR on the results of percutaneous balloon mitral valvotomy (PBMV) are insufficient. To detect the role of PVR in predicting residual PH immediately after PBMV. This prospective study comprised 49 consecutive patients with moderate to severe MS who were investigated pre and within 48 h post a successful PBMV for the first time. Echocardiography was used to assess the mitral valve area (MVA), mean transmitral pressure gradient (MPG), mitral valve resistance (MVR), right ventricular systolic pressure (RVSP) and PVR. Patients were classified into two groups according to the pre PVR (≥?1.6 WU as group I and < 1.6 as group II). At baseline compared to group II (32 patients), Group I (17 patients) had higher MPG (13.6?±?5.2 vs. 11.7?±?3.7 mmHg, P?<?0.05), RVSP (45.6 vs. 37.9 mmHg, P?<?0.001) and PVR (2.2?±?0.1 vs. 1.2?±?0.1WU, P?<?0.001) with no significant difference regarding age, gender, MVS, MVA and MVR. Patients of group I had comparatively lower improvement immediate post procedural of RVSP and PVR with no significant difference in immediate post procedural improvement in NYHA classification, MVA, MPG and MVR. Basal PVR?>?1.8WU was proved to be a highly specific (91%), a good predictor (AUC 0.78) of persistent elevation of RVSP?>?50 mmHg post PMV. Pathological rise of PVR that associates MS had provided a strong and an independent predictor of persistent pulmonary hypertension post PBMV and by this aspect it could be used as a valuable tool as MVA and MPG to send patients earlier for PBMV even with less severe MS. PVR?>?1.81 WU could be used as a noninvasive parameter for predicting regression of PH immediately after PBMV.     

近端等流速面面积法测算瓣口面积在二尖瓣狭窄球囊成形术前后应用的价值

近端等流速面面积（ＰＩＳＡ）法测定流量是基于点状孔推演出来的。为证实二尖瓣狭窄（ＭＳ）球囊成形术（ＰＢＭＶ）后该方法测算瓣口面积（ＭＶＡ）是否仍然适用，选取连续２０例接受ＰＢＭＶ治疗的风湿性ＭＳ患者，在ＰＢＭＶ前、后２４小时内行彩色多普勒检查，结果与心导管测值比较，显示ＰＳＩＡ法测算的ＭＶＡ和导管测值的相关性在ＰＢＭＶ前、后无显著性差异，而传统的压差半降时间法在ＰＢＭＶ后显著低估导管测值。