Wu Tongguo, Wang Lexin
Department of Cardiology, The Affiliated Hospital of Taishan Medical College, Taishan, People's Republic of China.
Can J Cardiol. 2003 Dec;19(13):1509-12.
Transseptal catheterization is the key to a successful percutaneous balloon mitral valvuloplasty (PBMV). The primary aim of the study was to investigate new methods of transseptal catheterization for PBMV.
Eighty-four patients with rheumatic mitral stenosis were randomized into two groups for PBMV. In the study group, the left atrial (LA) impression on the esophagus after a barium swallow was used as a reference of LA silhouette to determine the septal puncture site. In the control group, the LA silhouette under a normal fluoroscopic view was used for the determination of septal puncture site.
In the study group, the average length of esophagus impression after a barium swallow was similar to the size of the left atrium measured by angiography (43.8+/-0.6 mm versus 44.1+/-0.7 mm, n=42, P>0.05). The success rate of atrial septum puncture in the study and control groups were 100% and 64.3%, respectively (P<0.01). Transseptal catheterization was subsequently achieved using the barium swallow approach in the 15 initially unsuccessful patients from the control group. PBMV was successful in the 84 patients with significant reduction in LA pressure and improvement of clinical symptoms.
Transseptal catheterization in patients undergoing PBMV can be safely and effectively performed using the barium swallow approach.
经房间隔穿刺是经皮球囊二尖瓣成形术（PBMV）成功的关键。本研究的主要目的是探讨用于PBMV的经房间隔穿刺新方法。
84例风湿性二尖瓣狭窄患者被随机分为两组进行PBMV。研究组以吞钡后食管上的左心房（LA）压迹作为LA轮廓的参考来确定房间隔穿刺部位。对照组在正常透视下以LA轮廓来确定房间隔穿刺部位。
研究组吞钡后食管压迹的平均长度与血管造影测量的左心房大小相似（43.8±0.6mm对44.1±0.7mm，n = 42，P>0.05）。研究组和对照组的房间隔穿刺成功率分别为100%和64.3%（P<0.01）。随后，在对照组最初未成功的15例患者中采用吞钡法实现了经房间隔穿刺。84例患者PBMV成功，LA压力显著降低，临床症状改善。
采用吞钡法可安全有效地对接受PBMV的患者进行经房间隔穿刺。
