[经皮二尖瓣球囊成形术。即刻结果、并发症及住院结局]

[Percutaneous balloon mitral valvoplasty. Immediate results, complications and hospital outcome].

作者信息

Peixoto E C, de Oliveira P S, Netto M S, Villella R A, Labrunie P, Borges I P, Peixoto R T

机构信息

Cinecor (Pró-Cardíaco e 4. Centenário), Rio de Janeiro.

出版信息

Arq Bras Cardiol. 1995 Feb;64(2):109-16.

PMID:7575154

Abstract

PURPOSE

To study the short-term results, complications and in-hospital follow-up of 223 percutaneous mitral balloon valvuloplasty (PMBV) procedures (proc)in 219 patients.

METHODS

It was used a single 20mm balloon diameter in 4 proc, double balloon in 7, Inoue balloon in 4 and low profile balloon in 196. The mean-age group was 37.19 years. One hundred eighty three (82.1%) procedures were performed in women (mean age, 36.99 years) and 40 (17.9%) in men (mean age, 38.10 years) (p = 0.63). Patients were in functional class II, (NYHA) in 25 (11.2%) procedures, class III in 165 (74.0%) and class IV in 33 (14.8%). Patients were in sinus rhythm in 182 procedures (81.6%) and in atrial fibrillation in 41 (18.4%). The echocardiographic score range from 4 to 14 (7.4% +/- 1.7). Among 4 and 11 were 98.2% of patients.

RESULTS

We had 203 complete proc and success, mitral valve area (MVA) > or = 1.5cm2 after PMBV in 194 proc. Echocardiographic MVA before PMBV was 0.9 +/- 0.2cm2 and after 1.8 +/- 0.3cm2 (p < 0.01). Hemodynamic measures MVA before PMBV was 0.9 +/- 0.2cm2 and after was 1.9 +/- 0.3cm2 (p < 0.01). Mean pulmonary artery pressure decreased from 39 +/- 14mmHg to 27 +/- 11mmHg (p < 0.01) and mitral mean gradient from 20 +/- 9mmHg to 6 +/- 5mmHg (p < 0.01). In the 203 proc, mitral valve (MV) was competent in 176 and there were 1+ mitral regurgitation (MR) in 27. After PMBV, MV was competent in 126, and there were 1+ MR in 60, 2+ in 10.3+ in 6 and 4+ MR in 1. There was complication in 15 proc, severe MR in 7 (3 or 4+), stroke in 3 and cardiac tamponade in 5. Two patients died during emergency cardiac surgery after left ventricular perforation and one by stroke.

CONCLUSION

PMBV was an effective procedure with a high grade of success and low rate of complication.

摘要

目的

研究219例患者223例经皮二尖瓣球囊成形术（PMBV）的短期结果、并发症及院内随访情况。

方法

4例手术使用单个直径20mm的球囊，7例使用双球囊，4例使用Inoue球囊，196例使用低剖面球囊。平均年龄组为37.19岁。183例（82.1%）手术由女性进行（平均年龄36.99岁），40例（17.9%）由男性进行（平均年龄38.10岁）（p = 0.63）。患者心功能分级为Ⅱ级（纽约心脏协会[NYHA]）的有25例（11.2%），Ⅲ级的有165例（74.0%），Ⅳ级的有33例（14.8%）。182例手术患者为窦性心律（81.6%），41例为心房颤动（18.4%）。超声心动图评分范围为4至14分（7.4%±1.7）。4至11分的患者占98.2%。

结果

203例手术成功完成，194例经皮二尖瓣球囊成形术后二尖瓣瓣口面积（MVA）≥1.5cm²。经皮二尖瓣球囊成形术前超声心动图测得的MVA为0.9±0.2cm²，术后为1.8±0.3cm²（p<0.01）。血流动力学测量显示，经皮二尖瓣球囊成形术前MVA为0.9±0.2cm²，术后为1.9±0.3cm²（p<0.01）。平均肺动脉压从39±14mmHg降至27±11mmHg（p<0.01），二尖瓣平均压差从20±9mmHg降至6±5mmHg（p<0.01）。在203例手术中，二尖瓣（MV）功能正常的有176例，二尖瓣反流（MR）1+级的有27例。经皮二尖瓣球囊成形术后，MV功能正常的有126例，MR 1+级的有60例，2+级的有10例，3+级的有6例，4+级的有1例。15例手术出现并发症，严重MR 7例（3或4+级），中风3例，心脏压塞5例。2例患者在左心室穿孔后急诊心脏手术期间死亡，1例死于中风。