经皮二尖瓣扩张术治疗老年及老年前期患者二尖瓣狭窄

目的　探讨经皮经房间隔穿刺二尖瓣扩张治疗老年和老年前期患者二尖瓣狭窄的临床意义。方法　 86例患者采用一步法经皮经房间隔穿刺球囊扩张治疗二尖瓣狭窄。手术前后分别记录右心房压、左心房压、肺动脉压 ,二尖瓣口面积 ,并进行手术后随防。结果　 86例患者中 83例治疗成功 ,3例失败 ,其中 1例为术中急性心包填塞 ,2例术后出现中度二尖瓣反流。术后即刻 ,左心房压、肺动脉压下降 ,二尖瓣口面积增加 ,心功能改善。 4 2例患者随访(4 .4± 2 .1)年 ,1例出现再狭窄 ,1例原因不明猝死 ,1例因二尖瓣反流行瓣膜置换术 ,其余患者心功能和生活质量明显改善。结论　对年龄≥ 5 0岁伴轻度二尖瓣和 (或 )主动脉瓣反流 ,瓣膜钙化或瓣下结构病变的二尖瓣狭窄患者 ,可安全有效地施行球囊二尖瓣成形术。

One-step method for percutaneous balloon mitral valvuloplasty in the senile and pre-senile patients with mitral stenosis

Objectives To explore the result of percutaneous balloon mitral valvuloplasty (PBMV) in 86 senile and pre-senile patients with rheumatic mitral stenosis.Methods A new one-step method was used for percutaneous balloon mitral valvuloplasty in these cases with mitral stenosis. Right atrial pressure(RAP),left atrial pressure(LAP),pulmonary artery pressure(PAP) and mitral valve area(MVA) were measured before and after the procedure,respectively. Long-term followed up were made in 42 cases.Results PBMV was successful in 83 cases, with increase in MVA. LAP and PAP decreased, the heart function and clinical symptom improved remarkedly after PBMV. PBMV failed in 3 cases. Cardiac tamponade occurred in 1 patients and moderate mitral regurgitation in two cases. Forty-two cases were followed for (4.4±2.1)years (ranged from 12 months to 9 years) after PBMV. Restenosis detected by echocardiography was seen in 1 patient. Death occurred in 1 patient, mitral valve replacement was performed in 1 patient and cardiac function improved further in 39 patients. Conclusion PBMV can be performed safely and successfully in selected patients≥50 years old with mild mitral valve calcification and regurgitation or submitral lesions.