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经皮经静脉二尖瓣交界切开术治疗二尖瓣狭窄患者的长期临床和超声心动图结果

Long-term clinical and echocardiographic outcome in patients with mitral stenosis treated with percutaneous transvenous mitral commissurotomy.

作者信息

Saeki F, Ishizaka Y, Tamura T

机构信息

Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.

出版信息

Jpn Circ J. 1999 Aug;63(8):597-604. doi: 10.1253/jcj.63.597.

Abstract

Long-term follow-up after percutaneous transvenous mitral commissurotomy (PTMC) is limited. Ninety-four middle-aged (51+/-9 years) mitral stenosis patients who underwent successful PTMC were followed up with annual echocardiography for 6.1+/-1.4 years. PTMC success was defined as either mitral valve area (MVA) >1.5 cm2 or a MVA of more than twice the pre-procedural value, together with no worsening of mitral regurgitation >grade 2+. Mitral valve replacement (MVR), worsening of congestive heart failure (CHF), and thromboembolism were sought for survival analysis. Restenosis was defined as loss of more than 50% of the initial procedural MVA gain. Functional limit of daily activities was assessed through a questionnaire. The study population was divided into group 1 (post-procedural MVA >2.0 cm2), group 2 (MVA > 1.5 cm2 and < or = 2.0 cm2) and group 3 (MVA < or = 1.5 cm2). The 6-year survival with freedom from MVR, CHF, thromboembolism, and combined events (MVR+CHF) was 92%, 95%, 91%, and 88%, respectively. No group 1 patient experienced MVR or CHF. Restenosis was predominant in group 3. Deterioration of daily activities during follow-up was not observed in group 1; however, it was significant in group 2 (p<0.05) and group 3 (p<0.001). These results demonstrated that patients who attained a large MVA (>2.0cm2) immediately after PTMC maintained their procedural benefit with less clinical complication and with less limitation of daily activity.

摘要

经皮经静脉二尖瓣交界切开术(PTMC)后的长期随访数据有限。94例成功接受PTMC的中年(51±9岁)二尖瓣狭窄患者接受了每年一次的超声心动图随访,随访时间为6.1±1.4年。PTMC成功的定义为二尖瓣瓣口面积(MVA)>1.5 cm²或MVA大于术前值的两倍,且二尖瓣反流无恶化至2+级以上。对二尖瓣置换术(MVR)、充血性心力衰竭(CHF)恶化和血栓栓塞进行生存分析。再狭窄定义为初始手术MVA增益损失超过50%。通过问卷评估日常活动的功能受限情况。研究人群分为1组(术后MVA>2.0 cm²)、2组(MVA>1.5 cm²且≤2.0 cm²)和3组(MVA≤1.5 cm²)。无MVR、CHF、血栓栓塞和联合事件(MVR+CHF)的6年生存率分别为92%、95%、91%和88%。1组患者均未发生MVR或CHF。再狭窄在3组中最为常见。1组在随访期间未观察到日常活动能力下降;然而,2组(p<0.05)和3组(p<0.001)有显著下降。这些结果表明,PTMC术后立即获得大MVA(>2.0cm²)的患者能维持手术获益,临床并发症较少,日常活动受限也较少。

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