Padial L R, Abascal V M, Moreno P R, Weyman A E, Levine R A, Palacios I F
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Am J Cardiol. 1999 Apr 15;83(8):1210-3. doi: 10.1016/s0002-9149(99)00061-2.
Severe mitral regurgitation (MR) following mitral balloon valvuloplasty is a major complication of this procedure. We recently described a new echocardiographic score that can predict the development of severe MR following mitral valvuloplasty with the double balloon technique. The present study was designed to test the usefulness of this score for predicting severe MR in patients undergoing the procedure using the Inoue balloon technique. From 117 consecutive patients who underwent mitral valvuloplasty using the Inoue technique, 14 (11.9%) developed severe MR after the procedure. A good quality echocardiogram before mitral valvuloplasty was available in 11 patients. These 11 patients were matched by age, sex, mitral valve area, and degree of MR before valvuloplasty with 69 randomly selected patients who did not develop severe MR after Inoue valvuloplasty. The total MR-echocardiographic (MR-echo) score was significantly greater in the severe MR group (10.5 +/- 1.4 vs 8.2 +/- 1.1; p <0.001). In addition, the component grades for the anterior leaflet (2.9 +/- 0.5 vs 2.2 +/- 0.4; p <0.001), posterior leaflet (2.6 +/- 0.7 vs 1.9 +/- 0.8), commissures (2.4 +/- 0.8 vs 2.0 +/- 0.5; p <0.05) and subvalvular apparatus (2.6 +/- 0.5 vs 1.9 +/- 0.4; p <0.001) were also higher in the MR group. Using a total score of > or = 10 as a cut-off point for predicting severe MR with the Inoue technique, a sensitivity of 82%, specificity of 91%, accuracy of 90%, and negative predictive value of 97% were obtained. Stepwise logistic regression analysis identified the MR-echo score as the only independent predictor for developing severe MR with the Inoue technique (p <0.0001). Thus, the MR-echo score can also predict the development of severe MR following mitral balloon valvuloplasty using the Inoue technique.
二尖瓣球囊成形术后发生的严重二尖瓣反流（MR）是该手术的主要并发症。我们最近描述了一种新的超声心动图评分系统，它可以预测采用双球囊技术进行二尖瓣成形术后严重MR的发生情况。本研究旨在测试该评分系统对于预测采用Inoue球囊技术进行手术的患者发生严重MR的有效性。在117例连续接受Inoue技术二尖瓣成形术的患者中，有14例（11.9%）术后发生了严重MR。11例患者在二尖瓣成形术前有质量良好的超声心动图。这11例患者在年龄、性别、二尖瓣瓣口面积以及成形术前MR程度方面与69例随机选择的Inoue二尖瓣成形术后未发生严重MR的患者相匹配。严重MR组的总MR超声心动图（MR-echo）评分显著更高（10.5±1.4对8.2±1.1；p<0.001）。此外，MR组前叶（2.9±0.5对2.2±0.4；p<0.001）、后叶（2.6±0.7对1.9±0.8）、瓣叶联合处（2.4±0.8对2.0±0.5；p<0.05）以及瓣下结构（2.6±0.5对1.9±0.4；p<0.001）的各组成分级也更高。以总分≥10作为预测Inoue技术严重MR的截断点，得到的敏感度为82%，特异度为91%，准确度为90%，阴性预测值为97%。逐步逻辑回归分析确定MR-echo评分是采用Inoue技术发生严重MR的唯一独立预测因素（p<0.0001）。因此，MR-echo评分也可以预测采用Inoue技术进行二尖瓣球囊成形术后严重MR的发生情况。
