Bozat Tahsin, Koca Vedat, Akkaya Vakur
Bursa Postgraduate Hospital, Bursa, Turkey.
J Heart Valve Dis. 2003 Nov;12(6):707-11.
Customarily, heparin is used to prevent embolic complications arising during percutaneous mitral balloon valvuloplasty (PMBV), but this may prolong hospital stay and increases the risk of bleeding, hemopericardium and cardiac tamponade. The study aim was to assess in-hospital complications of PMBV performed without heparin.
Rheumatic mitral stenosis patients undergoing PMBV between February 1997 and March 2000, either with (18 males, 91 females; mean age 37.5 +/- 8.8 years) or without (15 males, 119 females; mean age 37.5 +/- 15.1 years) heparin at conventional doses, were included in the study. Neurologic and cardiac examinations were conducted after PMBV and repeated before discharge from hospital.
There was no statistically significant difference between groups in terms of age, gender, NYHA class, presence of atrial fibrillation, spontaneous echo contrast, left atrial appendix thrombus, left atrial diameter and mitral valve echo score. There was no difference between groups with regard to procedural success, mitral valve area and gradient attained, or rates of mitral insufficiency. Ten patients in the heparin group required transesophageal echocardiography (TEE) guidance during PMBV (p <0.001). The mean duration of PMBV was greater in the heparin group due to increased use of TEE guidance during septal puncture. During follow up, no patients in the non-heparin group had hemopericardium, cardiac tamponade, embolic event or death; by comparison, in the heparin group one patient had hemopericardium and one had a cardiac tamponade. No major bleeding episode requiring transfusion occurred in either group, but six and 10 cases of minor bleeding at access sites occurred in the non-heparin and heparin groups, respectively (p = NS). Duration of hospitalization was statistically longer in the heparin group than in the non-heparin group.
Avoidance of heparin did not lead to an increase in embolic complications. The vascular access sites were withdrawn early, thereby reducing the duration of hospital stay and time to ambulation. This method did not cause any increase in numbers of vascular complications and blood transfusions.
通常，肝素用于预防经皮二尖瓣球囊成形术（PMBV）期间出现的栓塞并发症，但这可能会延长住院时间并增加出血、心包积血和心脏压塞的风险。本研究的目的是评估在不使用肝素的情况下进行PMBV的院内并发症。
纳入1997年2月至2000年3月期间接受PMBV的风湿性二尖瓣狭窄患者，其中一部分患者（18例男性，91例女性；平均年龄37.5±8.8岁）使用常规剂量肝素，另一部分患者（15例男性，119例女性；平均年龄37.5±15.1岁）不使用肝素。PMBV后进行神经和心脏检查，并在出院前重复检查。
两组在年龄、性别、纽约心脏协会（NYHA）分级、房颤存在情况、自发回声增强、左心耳血栓、左心房直径和二尖瓣回声评分方面无统计学显著差异。两组在手术成功率、二尖瓣面积和跨瓣压差或二尖瓣关闭不全发生率方面无差异。肝素组有10例患者在PMBV期间需要经食管超声心动图（TEE）引导（p<0.001）。由于在房间隔穿刺期间更多地使用TEE引导，肝素组的PMBV平均持续时间更长。在随访期间，非肝素组没有患者发生心包积血、心脏压塞、栓塞事件或死亡；相比之下，肝素组有1例患者发生心包积血，1例患者发生心脏压塞。两组均未发生需要输血的严重出血事件，但非肝素组和肝素组分别有6例和10例穿刺部位轻微出血病例（p=无显著性差异）。肝素组的住院时间在统计学上比非肝素组长。
避免使用肝素并未导致栓塞并发症增加。血管穿刺部位提前拔除，从而缩短了住院时间和下床活动时间。该方法未导致血管并发症和输血次数增加。
