Evaluation Of The Effect Of Percutaneous Balloon Mitral Valvuloplasty Guided By "Clock-Pointer-Locating Method" Of Atrial Septum Puncture

Objective:To evaluate the effect of percutaneous balloon mitral valvuloplasty(PBMV)guided by " Clock-pointer-locating method " of atrial septum puncture point.Method:From January 2016 to February 2019,Total of 203 patients who receiving PBMV for rheumatic mitral stenosis(RMS)were included into the study and divided into 2 groups: 129 patients by " well-positioning method" were in group A,and 74 patients by " Clock-pointer-locating method " in group B.Both the groups were received the same procedure except of the methods of atrial septum puncture(ASP).Some parameters were compared between the two groups,including the operative duration,X-ray exposure time,the primary success rate of ASP,the rate of left atrial cardiography,the success rate of PBMV and complication rate.The mean left atrial pressure(mLAP)and mitral valve orifice area(MVA)were analyzed between preand post-operation.The chi-square test was used for counting data.The measurement data were firstly tested for normality and homogeneity of variance.The measurement data conforming to normal distribution were expressed as mean±standard deviation(sx ±),tested by Independent sample t test for comparison between the two groups,and tested by paired sample t test between pre-and post-operation.The measurement data that do not conform to the normal distribution,expressed by the median(25%digits,75% digits)[P50(P25,P75)],and tested by the mann-whitney U test.Test level = 0.05(both sides),P?0.05 was considered statistically significant.Results:There were no significant differences in gender,age,body mass index,heart rhythm,heart rate,cardiac function grading and composition ratio of patients with other valve lesions between group A and group B(P?0.05).There were no significant differences in mLAP(19.80±6.22 mmHg vs 19.83±8.01 mmHg,P=0.98),MVA(0.90±0.21 cm~2 vs 0.96±0.22 cm~2,P=0.07)before operation,and in mLAP(13.10±5.13 mmHg vs 14.38±5.13 mmHg,P=0.10),MVA(1.50±0.23 cm~2 vs 1.52±0.21 cm~2,P=0.69)after operation between the two groups(P ? 0.05).Compared with pre-operation,post-operative mLAP significantly decreased from 19.80±6.22 mmHg to 13.10±5.13 mmHg in group A(P?0.05),and from 19.83±8.01 mmHg to 14.38±5.13 mmHg in group B(P?0.05),while MVA significantly increased from 0.90±0.21 cm~2 to 1.50±0.23 cm~2 in group A(P?0.05),and from 0.96±0.22 cm~2 to 1.52±0.21 cm~2 in group B(P?0.05).Compared with group A,the operation duration [40(30,50)min vs 50(36,68)min,P=0.01] and X-ray exposure time [5.26(4.21,7.43)min vs 8.41(5.18,13.33)min,P=0.00] were statistically shorter in group B(P?0.05).Compared with group A,the primary success rate of ASP(90.54% vs 79.84%,P=0.047)was statistically higher,while the rate of left atrial cardiography(18.82% vs32.56%,P=0.036)was statistically shorter in group B(P?0.05).There was no significant difference in success rate(84.50% vs 90.54%,P=0.22)and complication rate(5.43% vs 1.35%,P=0.15)between A and B(P?0.05).Conclusion:" Clock-pointer-locating method " in the guidance of PBMV atrial septal puncture,compared with " well-position method ",the same is safe and effective,and the operation more convenient,more easy to beginners to master,can obviously shorten the operative duration and X-ray exposure time,reduce invalid puncture and left atrial angiography,which can be used to guide the atrial septal puncture,experience is worth promoting.