经皮二尖瓣球囊扩张术治疗风湿性心脏病二尖瓣狭窄合并二尖瓣中重度关闭不全的疗效

目的 探讨经皮二尖瓣球囊扩张术（percutaneous balloon mitral valvuloplasty,PBMV）治疗风湿性心脏病二尖瓣狭窄合并二尖瓣中重度关闭不全的临床效果.方法 56例风湿性心脏病二尖瓣狭窄合并二尖瓣关闭不全患者中,单纯二尖瓣重度狭窄（A组）30例,二尖瓣中度反流（B组）10例,二尖瓣重度反流（C组）16例.均用改进的inoue球囊技术通过逐步扩张法进行PBMV治疗.结果 3组二尖瓣口面积较术前均明显增加（均P＝0.000）,术前与术后差值B、C组与A组比较差异有统计学意义（P＜0.05）,B组与C组比较差异无统计学意义（P＞0.05）.A组二尖瓣反流面积较术前明显增加（P＝0.005）,但不影响疗效;B、C组二尖瓣反流面积较术前明显下降（P＝0.014,P=0.010）,且C组下降较B组明显（P＜0.05）.3组术后左心房较术前均明显减小（P＝0.001,P＝0.009,P=0.024）,3组左心房大小术前与术后差值比较差异无统计学意义（P＞0.05）.结论 PBMV治疗风湿性心脏病二尖瓣狭窄合并中、重度反流有显著疗效.

Curative Effects of Percutaneous Balloon Mitral Valvuloplasty on Rheumatic Mitral Stenosis Complicated by Moderate to Severe Mitral Regurgitation

Objective To investigate the curative effects of percutaneous balloon mitral valvu loplasty（PBMV） on rheumatic mitral stenosis complicated by moderate to severe mitral regurgita tion. Methods Fifty-six patients with rheumatic mitral stenosis and mitral regurgitation were divided into three groups ： pure severe mitral stenosis （group A, n =30）, moderate mitral regurgita tion（group B, n = 10）, and severe mitral regurgitation（group C, n= 16）. PBMV was performed u- sing the modified Inoue balloon technique. Results The mitral valve area significantly increased after operation（all P=0. 000）. The difference between preoperative and postoperative mitral valve area in group A was different from that in group B and C（P〈0.05） ,but there was no significant difference between the two groups（P〉〈0.05）. After operation,mitral regurgitation area increasedin group A（P=0. 005）,but decreased in group B and C（P=0. 014,P=0. 010）. Moreover,the de crease in mitral regurgitation area in group C was more obvious than that in group B（P（0.05）. The left atrium significantly reduced after operation（P=0. 001, P = 0. 009, P = 0. 024）, but there were no significant differences in the reduced values among the three groups（P〉0.05）. Conclu sion PBMV is effective for rheumatic mitral stenosis complicated by moderate to severe mitral regurgitation.