A Serial Study Of Echocardiography In Guiding And Evaluating Percutaneous Balloon Mitral Valvuloplasty

1st part: Echocardiographic evaluation of PBMV and morphologic analysis of MSTo evaluate the efficacy of PBMV, a total of 229 cases of MS with pre, post PBMV and follow-up echocardiographic data in recent 3 years were analyzed. MVAb and MVAd, MVOD, MV-V and MV-PG, LAD1, LAV, LASR, MVR, cardiac functional indexes such as CO and EF, morphology of the mitral valve before and after PBMV showed mat after PBMV, both MVAb and MVAd, AA, AP, APD and TD increased remarkably (p<0.05-0.001), with MVOD increased about 80%; MV-V, MV-PG, MV-Vm and PGm. decreased remarkably (p<0.001); CO, EF and some other cardiac indexes were also increased; LAD1, LAV reduced than pre PBMV (p<0.01), LASR was 10.3%. The results showed a good short outcome of PBMV, even when the patients' age were older than 60 years and the Wilkins score was higher than 8. Compared with post PBMV data, the follow-up (mean 10.5 months) showed that MVAb were smaller (p<0.05), but no differences between MVAd, MV-V and MV-PG (p>0.05). The results revealed that restenosis could not be excluded after PBMV. 2nd part: Role of real-time 2-demensional echocardiography in guiding IAS puncture of PBMVIn this study, 35 patients was selected for PBMV with 2DE guidance. During the procedure, when the catheter entered right atrium from inferior vena cave, 2DE was operated to monitoring the shape and direction of the catheter. The average length of the catheter that 2DE showed was 2~7cm. When the puncture needle with its sheath slipped down from superior vena cava to the area of foramen ovale, 2DE showed with apical 4-chamber view that the needle was located at the upper and middle 1/3 part of the IAS without shift, in great artery short axis view the needle was separated with AO with a distance of about 1.5 can. Puncturing at this site would not perforate the AO and also, the followed procedure would performed without a hitch due to the puncture site. There were some difficulties to show the needle tip with 2DE because of the stronger echo of the needle. But when the needle punctured through the IAS and entered LA, some bubble contained in the normal saline of the needle would appeared in the LA showed that the puncture was succeeded. All 35 patients were punctured under the guidance of 2DE and all showed good results without complications. It was manifested that 2DE guidance for IAS puncture was a safe and reliable method and simplified the procedure of putting a pigtail catheter through the femoral artery to the AO root to serve as a mark.