文章摘要
戴 剑,孔祥清,吴晓馗.老年人经皮球囊二尖瓣成型术临床应用[J].南京医科大学学报,2007,(7):740~743
老年人经皮球囊二尖瓣成型术临床应用
Study and evaluation of percutaneous balloon mitral valvuloplasty in senile cases
投稿时间:2006-12-19  
DOI:10.7655
中文关键词: 二尖瓣狭窄  老年人  球囊扩张
英文关键词: mitral valve stenosis  senile  balloon mitral valvuloplasty
基金项目:
作者单位
戴 剑 南京医科大学第一附属医院心内科,江苏 南京 210029 
孔祥清 南京医科大学第一附属医院心内科,江苏 南京 210029 
吴晓馗 南京胸科医院心内科,江苏 南京 210029 
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中文摘要:
      目的:评价经皮球囊二尖瓣成型术(PBMV)治疗老年人二尖瓣狭窄患者的临床意义?探讨老年人二尖瓣狭窄患者的手术适应证?围手术期处理方案?方法:选择≥60岁风心病,二尖瓣狭窄患者56例,采用改良Inoue方法行PBMV ?以血液动力学,超声心动图评价术前,术后即刻左房压(LAP)?二尖瓣瓣口面积(MVA)及二尖瓣跨瓣压差(MVG); 左心房直径(LAD)?超声心动图评价术后即刻和术后1年MVA ?MVG?LAD?结果:56例患者中54例治疗成功,2例失败?其中1例为术中球囊跨瓣失败,1例术后出现中度二尖瓣返流?术后即刻LAP由扩张前(22.5 ± 6.2)mmHg(1 mmHg =0.133 kPa)降至(13.8 ± 4.6)mmHg(P < 0.01);MVA由(1.05 ± 0.21)cm2增至(1.78 ± 0.22)cm2(P < 0.01);MVG由(18.3 ± 5.2)mmHg降至(10.6 ± 4.2)mmHg(P < 0.01)?术后即刻 LAP?MVG下降,MVA增加?术后1年LAD由(4.71 ± 0.73)cm减小到(4.39 ± 0.48)cm(P < 0.01),MVA,MVG和心功能与术后比较均无明显变化(P > 0.05).随访1年,3例出现再狭窄,1例死于换瓣手术,其余患者心功能和生活质量明显改善?结论:PBMV较为明显的改善二尖瓣狭窄症状,具有微创?低风险的特点?可适用于瓣膜轻度条件差和高危围术期而不适合二尖瓣置换术的老年患者?
英文摘要:
       Objective:To evaluate the effect of percutaneous balloon valvuloplasty(PBMV) in the elderly cases and study the adaptation and management with PBMV in these cases. Methods:This was a prospective single center clinical trial. A total of 56 cases whose age ≥60 years old were performed with modify Inoue PBMV. The hemodynamics and echocardiogram were used to evaluate the left atrial pressure(LAP), mitral valve area(MVA), mean gradient across the mitral valve(MVG), left atrial diameter(LAD) before procedure and immediately after procedure. The echocardiography assessment items before and one year after procedure included the MVA, MVG and LAD. Results:54 cases had successful operation in 56 paitents. 2 cases were failure. LAP from(22.5 ± 6.2)mmHg(1 mmHg = 0.133 kPa) before the operation decrease to(13.8 ± 4.6)mmHg immediately after the operation,(P < 0.01). MVA from(1.05 ± 0.21)cm2 before operation increase to(1.78 ± 0.22)cm2 immediately after operation(P < 0.01). MVG from(18.3 ± 5.2)mmHg before operation decrease to(10.6 ± 4.2)mmHg immediately after operation(P < 0.01). LAD from(4.71 ± 0.73)cm decrease to(4.39 ± 0.48)cm(P < 0.01) one year after operation. Restenosis detected by echocardiography was seen in 3 cases. One case died in mitral valve replacement performed. The echocardiography one year follow-up result showed that the effect of PBMV was constant. Conclusion:PBMV may be performed safely and successfully in old patients with mitral valve calcification and high risk, who can not afford mitral valve replacement.
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