【摘要】 目的 :探讨风湿性心脏病二尖瓣狭窄患者 PBMV术后左心耳功能和血流动力学改变。方法 :符合 PB-MV手术适应症的风湿性心脏病二尖瓣狭窄患者 2 3例 ,其中窦性心律 17例 ,心房颤动 6例 ,均于术前术后 3天内应用经胸及经食道超声技术检测二尖瓣瓣口面积、二尖瓣最大和平均跨瓣压差、左心房面积变化率和射血分数、左心耳最大容积、最小容积和射血分数。应用脉冲多普勒技术记录左心耳血流频谱。 PBMV术中穿刺房间隔成功后 ,鞘管置入左心房 ,测量左房最大压力、最小压力和平均压力。结果 :记录到的 2 3例患者中 ,窦性心律患者左心耳血流呈典型的双相频谱 ,房颤患者左心耳血流频谱则有两种类型 ,即呈“无血流状态”和“锯齿波”形。与 PBMV术前比较 ,术后二尖瓣瓣口面积扩大 ,二尖瓣最大和平均跨瓣压差下降 ,左房压力和肺动脉压力减低 ,左房面积和射血分数、左心耳容积和射血分数无显著性变化 ,左心耳血流显著加速。相关分析表明 PBMV术后左心耳最大前向血流速度与二尖瓣口面积正相关 (r=0 .5 1,P<0 .0 5 ) ,与二尖瓣平均跨瓣压差负相关 (r=- 0 .6 1,P<0 .0 1) ,与左房平均压负相关 (r=- 0 .6 4 ,P<0 .0 1)。结论 :成功的 PBMV术后左心耳血流动力学得到改善 ,但左心耳功能恢复是一个延迟改变的过程 ,提示 PBMV术更多还原

【Abstract】 Objective:To evaluate the hemodynamics and function of left atrial appendage before and after percutaneous balloon mitral valvuloplasty(PBMV) in patients with rheumatic mitral valvular stenosis.Methods:Twenty three patients,17 were in sinus rhythm and 6 were in atrial fibrillation, underwent transthoracic and transesophageal echocardiography before and within 72 hours after PBMV?Mitral valve area, transmitral pressure gradient,left atrial ejection fraction(LA-EF), left atrial appendage ejection fraction(LAA-EF),and left atrial appendage flow velocity patterns were recorded All patients underwent PBMV using the transvenous anterograde Japan Inoue technique,and the maximal left atrial pressure, minimal left atrial pressure and mean left atrial pressure were measured.Results:By Doppler method,3 distinct flow patterns were observed before the procedure, a "sinus pattern" in patients in sinus rhythm, and a "fibrillatory pattern" ( n =2) or a "no flow pattern" ( n =4) in patients with atrial fibrillation PBMV resulted in increasing in mitral valve area,decreasing in the maximal and mean transmitral pressure gradient, and decreasing in left atrial pressure.There were no significant change of LA-EF and LAA-EF before and after PBMV The LAA peak Doppler velocity was greatly increased after the procedure and the peak outflow velocity was positively correlated to the mitral valve area( r =0 51, P <0 05),was negtively correlated to transmitral pressure gradiant ( r =-0 61, P <0 01)and left atrial pressure( r =-0 64, P <0 01).Conclusions:Left atrial appendage hemodynamics was improved after successful PBMV, while left atrial mechanical function was not significantly improved 3 days after PBMV.It is necessary to use adequate anticoagulative therapy during and after PBMV in order to prevent thrombosis.更多还原