再次经皮球囊二尖瓣成形术临床效果观察

目的观察再次经皮球囊二尖瓣成形术（PBMV）治疗PBMV后二尖瓣再狭窄的临床效果。方法 82例PBMV后二尖瓣再狭窄的病人,再次采用我科小弧度法PBMV治疗,并进行近远期疗效随访。结果 82例病人经再次PBMV治疗后,成功78例,成功率为95.1%。术后病人左心房平均压、二尖瓣口面积、跨瓣压差、肺动脉收缩压明显改善,与术前比较差异有显著性（t=2.35~4.76,P均〈0.05）;而左心房内径无明显改变（t=1.54,P〉0.05）。78例病人术后随访（76±23）个月,结果二尖瓣口面积仍明显大于再次PBMV术前,跨瓣压差明显小于再次PBMV术前（t=2.16-3.68,P〈0.05）,且与术后即刻结果比较差异均无显著性（t=1.24-1.59,P均〉0.05）,大多数病人临床症状和生活质量明显改善。结论对于PBMV后再狭窄的病人,只要病例选择适当,手术操作正确,再次PBMV后即刻及远期疗效好。

OUTCOME AFTER REPEATED PERCUTANEOUS BALLOON MITRAL VALVULOPLASTY

Objective To observe the clinical outcome of repeated percutaneous balloon mitral valvuloplasty（PBMV） for restenosis after previous PBMV.Methods Eighty-two patients with mitral restenosis after previous PBMV were treated by repeated small curve PBMV.Short-and long-term follow-ups were conducted.Results Of the 82 patients treated,78（95.1%） were done well.Postoperatively,left atrial mean pressure,mitral valve area,mitral valve gradient and pulmonary artery systolic pressure improved significantly compared with pre-PBMV（t=2.35-4.76,P〈0.05）,but the inner diameter of the left atrium remained unchanged（t=1.54,P〈0.05）.A follow-up of（76±23） months showed that,compared with before surgery,the mitral valve area was still significantly larger,and the mitral valve gradient was less（t=2.16-3.68,P〈0.05）;compared with immediate results upon completion of the procedures,the differences of these parameters were not significant（t=1.24-1.59,P〈0.05）.Clinical symptoms and quality of life in most of the patients improved obviously.Conclusion Repeated PBMV has a good short-and long-term efficacy in patients with restenosis after previous balloon valvuloplasty as long as the patients are properly selected and the procedures are correctly performed.