Fawzy M E, Kinsara A J, Stefadouros M, Hegazy H, Kattan H, Chaudhary A, Williams E, Al Halees Z
Department of Cardiovascular Diseases and Basic Sciences, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
J Heart Valve Dis. 2001 Mar;10(2):153-7.
The study aim was to examine the long-term outcome (nine years) of mitral balloon valvotomy in pregnant patients with severe mitral stenosis.
Twenty-three patients with severe, symptomatic (NYHA class III/IV) mitral stenosis underwent mitral balloon valvotomy using an Inoue balloon technique during the second trimester of their pregnancy; mean follow up in 19 patients was 5.1 +/- 2.8 years (range: 1 to 9 years).
The procedure was successful in all patients. Immediately after valvotomy, the Doppler-derived mitral valve area increased from 0.90 +/- 0.18 to 1.97 +/- 0.36 cm2 (p <0.0001), and the transmitral mean gradient decreased from 15.7 +/- 4.7 to 5.5 +/- 1.6 mmHg (p <0.0001). Four patients had mild worsening of mitral regurgitation, and six developed insignificant interatrial communication immediately after valvotomy. There was no other morbidity or mortality. Patients showed a significant improvement in mean NYHA class, from 3.0 +/- 0.1 to 1.0 +/- 0.02 (p <0.001). Twenty-two patients had normal deliveries; one cesarean section in week 36 resulted in stillbirth. No developmental abnormalities were seen in the babies. At long-term follow up of mothers, the mitral valve area was 1.8 +/- 0.52 cm2; restenosis developed in three patients (16%). One baby died at one week from sudden infant death syndrome, and one at eight months, from pneumonia. All other children showed normal growth, development and speech for their age.
Mitral balloon valvotomy using the Inoue balloon technique can provide satisfactory immediate relief and long-term outcome in pregnant patients with severe mitral stenosis.
本研究旨在探讨重度二尖瓣狭窄孕妇行二尖瓣球囊瓣膜成形术的长期预后（9年）。
23例有症状的重度二尖瓣狭窄患者（纽约心脏协会心功能分级III/IV级）在妊娠中期采用Inoue球囊技术行二尖瓣球囊瓣膜成形术；19例患者的平均随访时间为5.1±2.8年（范围：1至9年）。
所有患者手术均成功。瓣膜成形术后即刻，经多普勒测量的二尖瓣瓣口面积从0.90±0.18cm²增加至1.97±0.36cm²（p<0.0001），二尖瓣平均跨瓣压差从15.7±4.7mmHg降至5.5±1.6mmHg（p<0.0001）。4例患者二尖瓣反流轻度加重，6例在瓣膜成形术后即刻出现无关紧要的房间隔交通。无其他并发症或死亡病例。患者纽约心脏协会心功能分级平均显著改善，从3.0±0.1降至1.0±0.02（p<0.001）。22例患者顺产；1例在36周时剖宫产，导致死产。婴儿未见发育异常。对母亲进行长期随访时，二尖瓣瓣口面积为1.8±0.52cm²；3例患者（16%）出现再狭窄。1例婴儿在1周时死于婴儿猝死综合征，1例在8个月时死于肺炎。所有其他儿童的生长、发育和语言能力与其年龄相符。
采用Inoue球囊技术行二尖瓣球囊瓣膜成形术可为重度二尖瓣狭窄孕妇提供满意的即刻缓解和长期预后。
