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对600例风湿性心脏病二尖瓣狭窄患者进行了经皮二瓣球囊扩张术(PBMV).患者分为第一阶段(1990年4月～1991年2月)114例,用Inoue方法;第二阶段(1991年3月～1995年3月)486例,术前和术中对操作技术进行了改进,其中包括:房颤者均常规抗凝治疗;伴有冠心病或ST-T改变者行冠脉造影;依Wiltins法对瓣膜结构评分,大于8分者只要前瓣活动好即可入选;采用三法定位校正法行房间隔穿刺;穿刺针指向根据左房大小进行调整;穿刺针扩张管进入左房时严密观测左房压力曲线,且缓慢推进不超过0.5cm;球囊导管在心房内呈反“C”形,根据左房大小调整位置和方向进入二尖瓣口;调整球囊在左室内的方向和位置;逐次递增球囊直径扩张二尖瓣等.结果:第一阶段114例,成功率为92.1%,并发症为7.9%(9/114).第二阶段486例,成功率为100%,无并发症.表明术前准备和术中操作技术的改进,可显著提高PBMV成功率,减少并发症,有临床应用价值.
Percutaneous balloon mitral valvuloplasty (PBMV) was performed in 600 patients with rheumatic mitral stenosis who were divided into 114 patients in the first phase (April 1990 to February 1991) using the Inoue method. In the second phase (March 1991-March 1995), 486 patients underwent preoperational and intraoperative operative techniques, including: Anticoagulation in patients with atrial fibrillation; Coronary heart disease or ST-T changes Coronary angiography; according to Wiltins method of valve structure score, as long as the anterior valve activity is greater than 8 points can be selected; using three positioning correction method atrial septal puncture; puncture needle to be adjusted according to the size of the left atrium; puncture needle Dilatation of the left atrial septal strict observation of the left atrial pressure curve, and slowly advancing not more than 0.5cm; balloon catheter in the atrium was inverted “C” shape, according to the left atrial size to adjust the position and direction into the mitral valve; adjust the ball Capsule in the left ventricular direction and position; successive balloon diameter expansion mitral valve, etc.Results: The first phase of 114 cases, the success rate was 92.1%, the complication was 7.9% (9/114), the second phase of 486 cases , The success rate was 100%, no complications.It shows that preoperative preparation and intraoperative operative techniques can significantly improve the success rate of PBMV, minus Complications, clinical value.