Demirtaş M, Usal A, Birand A, San M, Batyraliev T, Niyazova Z
Cukurova University Medical School, Department of Cardiology, Adana, Turkey.
Angiology. 1996 Mar;47(3):285-9. doi: 10.1177/000331979604700311.
Systemic embolism is a potential and severe complication of percutaneous balloon mitral valvuloplasty (PBMV). The incidence of systemic embolism during PBMV has been reported to be less than 5% and only 0.6% with the Inoue technique. This is less than that reported in closed commissurotomy series and about the same as in open commissurotomy. In the authors' series of 50 cases, the incidence of systemic embolism was 2% (1 case). The patient had mitral restenosis (after closed commissurotomy) with mild to moderate valvular and subvalvular calcification, and cerebral embolism occurred during the procedure. To prevent systemic embolism, the authors' standard policy was to perform transesophageal echocardiography (TEE), computed tomography, and magnetic resonance imaging before the procedure and to give heparin during the procedure and two months preceding it in cases with atrial fibrillation or with a history of previous embolism and to limit manipulation of the catheter in the left atrium. The authors believe that a close scrutiny in the selection of patients, improved technology of the dilating system, good experience with PBMV, and adequate heparinization are also of great importance in the prevention of thromboembolic complications.
系统性栓塞是经皮球囊二尖瓣成形术（PBMV）的一种潜在严重并发症。据报道，PBMV期间系统性栓塞的发生率低于5%，采用Inoue技术时仅为0.6%。这低于闭式二尖瓣交界切开术系列报道的发生率，与直视二尖瓣交界切开术的发生率大致相同。在作者的50例病例系列中，系统性栓塞的发生率为2%（1例）。该患者有二尖瓣再狭窄（闭式二尖瓣交界切开术后），伴有轻至中度瓣膜及瓣下钙化，术中发生脑栓塞。为预防系统性栓塞，作者的标准策略是在术前进行经食管超声心动图（TEE）、计算机断层扫描和磁共振成像检查，对于房颤或有既往栓塞史的患者，在术中及术前两个月给予肝素，并限制导管在左心房内的操作。作者认为，在患者选择上进行严格审查、改进扩张系统技术、积累丰富的PBMV经验以及充分肝素化对于预防血栓栓塞并发症也非常重要。
