柳昂,万琳媛,平措云旦,金敬琳,王珂,吴伟春,朱振辉,闫朝武

• 1:国家心血管病中心北京协和医学院中国医学科学院阜外医院结构性心脏病中心
• 2:国家心血管病中心北京协和医学院中国医学科学院阜外医院超声医学科
• 3:西藏自治区人民医院放射科

摘要(Abstract)：

目的 探讨经股动-静脉路径建立导丝轨道辅助经皮二尖瓣球囊成形术的安全性和可行性。方法 回顾性分析2015年1月至2022年10月在中国医学科学院阜外医院接受导丝轨道辅助下经皮二尖瓣球囊成形术的患者25例，女19例，平均年龄（61.60±9.00）岁，临床诊断均为风湿性心脏病二尖瓣重度狭窄。所有患者均穿刺房间隔，建立股静脉-房间隔-股动脉导丝轨道，经股静脉路径送入Inoue球囊对二尖瓣行逐级扩张（球囊直径：22.00～28.00 mm）。球囊扩张终点为二尖瓣瓣口面积≥1.50 cm~2伴轻度或以下二尖瓣反流。结果 25例患者均成功建立导丝轨道并完成二尖瓣球囊成形术。其中常规方法球囊导管跨瓣困难20例，瓣膜重度钙化16例，华法林抗凝6个月后仍合并左心耳血栓3例。所有患者术中平均球囊扩张直径为（25.00±1.40）mm。二尖瓣瓣口面积由术前（0.91±0.15）cm~2增加至术后（1.70±0.14）cm~2(P<0.001)；左心房平均压力由术前（27.00±7.50）mmHg降至术后（16.36±4.07）mmHg(P<0.001)；肺动脉平均压力由术前（40.84±13.81）mmHg降至术后（25.00±7.12）mmHg(P<0.001)。所有患者术后症状均获得明显改善，无手术相关并发症。结论 经股动-静脉路径建立导丝轨道行经皮二尖瓣球囊成形术安全可行，可作为复杂二尖瓣狭窄患者介入治疗的重要补充技术。

关键词(KeyWords)： 导丝轨道法;风湿性心脏病;二尖瓣狭窄;房间隔穿刺;球囊成形术

Abstract:

Keywords:

基金项目(Foundation): 中国医学科学院中央公益性科研院所重大支撑项目(2023-RW320-08);; 西藏自治区人民医院科技项目(XZQYY2024008)

作者(Author): 柳昂,万琳媛,平措云旦,金敬琳,王珂,吴伟春,朱振辉,闫朝武

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