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三腔单球囊导管经皮二尖瓣分离术的临床应用 |
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翁昌鸿 郭志刚 李崇信 宾建平 侯玉清 贾满盈 刘伊丽 钟汉权
【摘要】 目的 为评价三腔单球囊导管行经皮二尖瓣分离术(PTMC)的临床疗效。方法 术前行右心导管术测右室和肺动脉压，8F Mullins管和房间隔穿刺针穿刺房间隔,成功后肝素化,送入左房导丝到左心房,沿导丝送入三腔球囊导管进左房后操纵导管过二尖瓣口进左心室。同步测二尖瓣跨瓣压差, 迅速充盈球囊扩张二尖瓣口,至腰部凹形消失立即回抽空球囊并留置在左室内再次测二尖瓣跨瓣压差。术前、术后采用二维超声和彩色多谱勒血流仪检查,评价PTMC疗效、二尖瓣反流和有否房间隔缺损等情况。结果 本组58例成功率为100%。肺动脉收缩压由术前52.4±18.9mmHg,术后降至39.9±17.1mmHg (P<0.001); 二尖瓣跨瓣压差自术前17.7±8.2mmHg术后降至1.9±2.2mmHg(P<0.001); 二尖瓣口面积自术前1.0±0.2cm2术后扩大至2.1±0.3cm2(P<0.001); 术后心功能均得到改善。结论 三腔单球囊导管操作简单，毋须左心导管亦能同步测二尖瓣跨瓣压差，且无重要并发症，安全、疗效肯定。
【关键词】 二尖瓣狭窄 气囊扩张术
Percutaneous transvenous mitral commissurotomy with trilumen single balloon catheter Weng Changhong, Guo Zhigang, Li Chongxin, et al. Department of Cardiology, Nanfang Hospital, First Military Medical University, PLA, Guangzhou 510515
【Abstract】 Objective To assess the clinical efficiency of the trilumen single balloon catheter newly designed for percutaneous transvenous mitral commissurotomy (PTMC). Methods Fifty eight cases of rheumatic heart disease underwent PTMC. Before transseptal puncture, right cardic catheterization was performed through the right femoral vein to measure right ventricle and pulmonary artery pressure. Transseptal catheterization was performed with Brockenbrough needle and an 8F Mullins transseptal dilator. After entry into the left atrium, 10 000 units heparin was administered. A 0.28-in stainless steel guide wire was advanced into the left atrium and was used to place the trilumen balloon catheter in the left atrium, and direct the balloon tip into the left ventricle. The transvalvular gradient was measured. The balloon was inflated with diluted contrast material until the waist of the balloon disappeared. Immediately after the procedure, measurement of transvalvular gradient was repeated to assess the atrial septal defect, mitral regurgitation and efficiency. Two-dimensional and Doppler echocardiography were performed the day bef[1] [2] [3] 下一页
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