Ahmari Saeed Al, Amro Ahmed, Otabi Mohammed Al, Abdullah Moheeb Al, Kasab Saad Al, Amri Husien Al
Adult Cardiology Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
J Saudi Heart Assoc. 2012 Jan;24(1):23-7. doi: 10.1016/j.jsha.2011.08.002. Epub 2011 Oct 20.
BMV is an established treatment for rheumatic mitral valve stenosis. The procedure is historically guided by fluoroscopy, and the role of intracardiac echocardiogram (ICE) guidance is not well defined. We report our initial experience of using ICE to guide BMV procedures.
During BMV procedure, ICE catheter was inserted into the right atrium from the right femoral vein, and the septal puncture was monitored by ICE, as well as positioning of the balloon in the mitral valve. Comparisons were made between ICE, transthoracic echocardiography (TTE), and catheterization derived hemodynamic measurements (cath).
Seventeen patients with mitral stenosis underwent the procedure. The mean age was 44.4 ± 21 years. The mean MV area increased from 0.9 ± 0.1 cm(2) to 1.7 ± 0.2 cm(2), P < 0.0001 and the mean gradient decreased from 12.6 ± 5.8 mmHg to 4.9 ± 1.8 mmHg, P < 0.001. Atrial septum puncture and guidance of the balloon into the MV apparatus were obtained in all patients under ICE guidance. Severe MR developed in one patient and was readily detected by ICE. ICE derived gradient measurements were comparable to those obtained by TTE, and cath.
ICE guidance of BMV is feasible, and useful in monitoring safe septal puncture, optimizing balloon positioning, and in detecting complications. The hemodynamic measurements obtained were comparable to those obtained by TTE, and cath.
经皮球囊二尖瓣成形术（BMV）是治疗风湿性二尖瓣狭窄的既定疗法。从历史上看，该手术由荧光透视引导，而心内超声心动图（ICE）引导的作用尚未明确界定。我们报告了使用ICE引导BMV手术的初步经验。
在BMV手术期间，将ICE导管从右股静脉插入右心房，通过ICE监测房间隔穿刺以及球囊在二尖瓣中的定位。对ICE、经胸超声心动图（TTE）和心导管检查获得的血流动力学测量值（cath）进行了比较。
17例二尖瓣狭窄患者接受了该手术。平均年龄为44.4±21岁。二尖瓣平均面积从0.9±0.1cm²增加到1.7±0.2cm²，P<0.0001，平均压差从12.6±5.8mmHg降至4.9±1.8mmHg，P<0.001。在ICE引导下，所有患者均成功进行了房间隔穿刺并将球囊引导至二尖瓣装置。1例患者出现严重二尖瓣反流（MR），ICE很容易检测到。ICE获得的压差测量值与TTE和cath获得的测量值相当。
ICE引导BMV是可行的，有助于监测安全的房间隔穿刺、优化球囊定位以及检测并发症。获得的血流动力学测量值与TTE和cath获得的测量值相当。
