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目的:旨在研究一步法经皮球囊扩张术(PBMV)治疗风湿性心脏病二尖瓣狭窄和瓣膜分离术后二尖瓣再狭窄15年经验及长期随访。方法:摒弃传统的三步法,采用一步法经皮经房间隔穿刺球囊扩张治疗二尖瓣狭窄。结果:492例二尖瓣球囊扩张术成功率98·2%(483/492),术后二尖瓣口面积明显增加从(0·89±0·18)cm2至(2·21±0·41)cm2。211例随访8个月至9年2个月,二尖瓣再狭窄率为11·14%(24/211),病死率为(4·2/211),二尖瓣再置换术为5·2%(11/211)。46例二尖瓣闭式分离术后再狭窄。球囊扩张治疗后临床症状明显改善,二尖瓣外科术后再狭窄患者瓣口面积(MVA)由(1·03±0·28)cm2增至(1·94±0·27)cm2(P<0·001),其中28例随访(4·3±2·1)年,MVA为(1·81±0·27)cm2(与术前比较,P<0·001,与术后即刻比较,P>0·05),发生再狭窄3例,已成功第二次PBMV。结论:一步法PBMV治疗严重二尖瓣狭窄成功率高,并发症低;对年龄≥50岁伴轻度二尖瓣(和)主动脉瓣反流者,二尖瓣闭式分离术后再狭窄者,近远期疗效显著,具有创伤小,安全、有效可重复性等特点。
PURPOSE: To study the 15-year experience and long-term follow-up of mitral valve restenosis after mitral stenosis and valvular dissection after one-step percutaneous balloon dilation (PBMV) for rheumatic heart disease. Methods: To abandon the traditional three-step method, using one-step percutaneous transventricular septal puncture balloon dilatation of mitral stenosis. Results: The success rate of 492 cases of balloon mitral valvuloplasty was 98.2% (483/492). The area of mitral valve orifice increased from (0.89 ± 0.18) cm2 to (2.21 ± 0) · 41) cm2.211 cases were followed up for 8 months to 9 years and 2 months, mitral valve restenosis rate was 11.14% (24/211), the mortality rate was (4.2 / 211), mitral valve and then Replacement surgery was 5.2% (11/211). 46 cases of mitral regurgitation after restenosis. The clinical symptoms were significantly improved after balloon dilatation. The MVA increased from (1.03 ± 0.28) cm2 to (1.94 ± 0.27) cm2 (P (0 · 001). Among them, 28 cases were followed up (4.3 ± 2.1) years and MVA was (1.81 ± 0.27) cm2 (P <0.001, preoperatively , P> 0.05), restenosis occurred in 3 cases, the second PBMV has been successful. CONCLUSION: One-step PBMV has a high success rate of severe mitral stenosis with low complication rate. For patients with age ≥50 years with mild mitral valve (and) aortic regurgitation, restenosis after mitral valve stenosis In recent and long term, the curative effect is remarkable, with the characteristics of small trauma, safety, effective and repeatability.