Hung J S, Lau K W, Lo P H, Chern M S, Wu J J
Section of Cardiology, China Medical College and Hospital, Taichung, Taiwan, Republic of China.
Am Heart J. 1999 Jul;138(1 Pt 1):114-21. doi: 10.1016/s0002-8703(99)70255-3.
There have been no single-center studies that have systematically addressed the acute outcome of Inoue balloon mitral commissurotomy (BMC) performed in a large series of patients. Accordingly, this study sought to examine the impact of operator experience and continuing technical modifications on the success and complication rates of BMC.
BMC was performed in 799 patients: 469 patients with pliable mitral valves (group 1) and 330 patients with calcified valves and/or severe subvalvular disease (group 2). Acute complications were examined and compared between groups before and after modifications in BMC techniques. Major modifications included the use of a height-derived balloon sizing method for the selection of an appropriate balloon catheter, a cautionary stepwise dilation technique, and avoidance of traction on the interatrial septum during balloon inflations.
Technical failures were encountered in 4 (0.5%) patients in our early experience. One patient sustained cardiac perforation and tamponade and was the only case requiring emergency surgery. There were no deaths. Systemic embolic events were observed in 11 (1.4%), all among the first 353 patients before the routine use of pre-BMC transesophageal echocardiography. Severe postprocedure angiographic (>/=3+) mitral regurgitation occurred in 4% of patients, 2% in group 1 versus 9% in group 2 (P =.0001). With increased operator experience and technical modifications, this complication was significantly reduced from 5% (7 of 150 patients) to 0% in the last 316 patients in group 1 (P =.0001) and from 11% (26 of 228 patients) to 3% (3 of 101 patients) in group 2 (P =.031). The incidence of significant interatrial shunting (pulmonary-to-systemic flow ratio >/=1.3) was also significantly reduced from 12% to 6% (P =.0034).
Incremental operator experience and ongoing technical refinements in BMC techniques have resulted in a 100% technical success rate and a significant diminution in complications in patients with a wide spectrum of stenotic mitral valve morphologic features.
尚无单中心研究系统地探讨大量患者接受井上球囊二尖瓣交界切开术（BMC）的急性结局。因此，本研究旨在探讨术者经验及持续的技术改进对BMC成功率和并发症发生率的影响。
对799例患者实施了BMC：469例二尖瓣柔顺的患者（第1组）和330例瓣膜钙化和/或严重瓣下病变的患者（第2组）。在BMC技术改进前后，对两组患者的急性并发症进行了检查和比较。主要改进包括采用基于高度的球囊尺寸测量方法来选择合适的球囊导管、谨慎的逐步扩张技术以及在球囊充盈时避免牵拉房间隔。
在我们早期的经验中，有4例（0.5%）患者出现技术失败。1例患者发生心脏穿孔和心包填塞，是唯一需要急诊手术的病例。无死亡病例。观察到11例（1.4%）发生系统性栓塞事件，均在前353例患者中，这些患者在常规使用BMC前经食管超声心动图检查之前。术后严重血管造影（≥3+）二尖瓣反流发生率为4%，第1组为2%，第2组为9%（P = 0.0001）。随着术者经验增加和技术改进，这一并发症在第1组最后316例患者中从5%（150例患者中的7例）显著降至0%（P = 0.0001），在第2组中从11%（228例患者中的26例）降至3%（101例患者中的3例）（P = 0.031）。显著房水平分流（肺循环与体循环血流量比值≥1.3）的发生率也从12%显著降至6%（P = 0.0034）。
术者经验的增加和BMC技术的持续改进已使技术成功率达到100%，并显著减少了具有广泛狭窄二尖瓣形态特征患者的并发症。
