Srimahachota S, Boonyaratavej S, Wannakrairoj M, Udayachalerm W, Sangwattanaroj S, Ngarmukos P, Chayanont D
Cardiac Center, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok, Thailand.
J Med Assoc Thai. 2001 May;84(5):674-80.
Atrial fibrillation (AF) occurs frequently in severe rheumatic mitral stenosis (MS) and has been reported to be a predictor of poor outcome after percutaneous transvenous mitral commissurotomy (PTMC). Nevertheless, according to observations in our catheterization laboratory, patients with sinus rhythm (SR) seem to have a higher pulmonary artery pressure than AF.
To determine 1) the hemodynamic differences between MS patients with AF and SR before and after PTMC and 2) the success rate and difference in outcome between both groups.
A total of 145 patients who had undergone PTMC with the Inoue balloon technique in King Chulalongkorn Memorial Hospital between 1993 and 1997 were enrolled. The data were presented as mean +/- SD. Student t-test was used to compare the difference in hemodynamic and outcome between the AF and SR groups.
Fifty-six patients (38.6%) were in the AF group. The AF patients were older (42.0 +/- 11.3 vs 32.4 +/- 8.7 yr., p < 0.0001), had a larger left atrium (49.2 +/- 6.1 vs 45.3 +/- 4.9 mm, p < 0.001) and a higher valvular calcification score (1.8 +/- 0.6 vs 1.5 +/- 0.6, p = 0.02) than the SR group. There was no significant difference between baseline heart rate and overall MV score index. The hemodynamic data showed that the SR group had higher systolic (59.9 +/- 26.0 vs 47.4 +/- 16.8 mmHg, p < 0.05), diastolic (28.1 +/- 12.8 vs 22.7 +/- 9.2 mmHg, p < 0.05) and mean (40.1 +/- 17.1 vs 32.7 +/- 11.8 mmHg, p < 0.05) pulmonary artery (PA) pressure than the AF group. After successful PTMC, the SR group exhibited a more favorable change in all PA pressures and the transmitral valvular gradient (10.0 +/- 6.5 vs 6.7 +/- 6.5 mmHg, p < 0.01) than the AF group. Procedural success rates were 98 per cent in the AF and 96 per cent in the SR group (p = ns). Transthoracic colour-flow echocardiographic imaging detected atrial septal defects in 18.2 per cent and 7.5 per cent (p = 0.08) of the AF and SR groups, respectively. There was no systemic embolization, peri-procedural death or emergency surgery in both groups.
Patients with MS and AF were older, had a larger LA and lower pre-PTMC PA pressure than the patients who had MS and SR. In addition, patients with SR had a more favourable PA and LA pressure reduction than patients with AF.
房颤（AF）在重度风湿性二尖瓣狭窄（MS）中频繁发生，并且据报道是经皮经静脉二尖瓣交界切开术（PTMC）后预后不良的一个预测指标。然而，根据我们导管实验室的观察，窦性心律（SR）患者的肺动脉压似乎比房颤患者更高。
纳入1993年至1997年在朱拉隆功国王纪念医院采用Inoue球囊技术接受PTMC的145例患者。数据以均值±标准差表示。采用学生t检验比较AF组和SR组在血流动力学及预后方面的差异。
AF组有56例患者（38.6%）。AF患者比SR组年龄更大（42.0±11.3岁对32.4±8.7岁，p<0.0001），左心房更大（49.2±6.1mm对45.3±4.9mm，p<0.001），瓣膜钙化评分更高（1.8±0.6对1.5±0.6，p = 0.02）。基线心率和总体二尖瓣评分指数之间无显著差异。血流动力学数据显示，SR组的收缩期（59.9±26.0mmHg对47.4±16.8mmHg，p<0.05）、舒张期（28.1±12.8mmHg对22.7±9.2mmHg，p<0.05）和平均（40.1±17.1mmHg对32.7±11.8mmHg，p<0.05）肺动脉（PA）压均高于AF组。成功PTMC后，SR组在所有PA压和跨二尖瓣压差方面的改善比AF组更明显（10.0±6.5mmHg对6.7±6.5mmHg，p<0.01）。AF组的手术成功率为98%，SR组为96%（p = 无显著性差异）。经胸彩色血流超声心动图成像分别在AF组和SR组中检测到18.2%和7.5%的房间隔缺损（p = 0.08）。两组均未发生系统性栓塞、围手术期死亡或急诊手术。
与MS和SR患者相比，MS和AF患者年龄更大，左心房更大，PTMC前PA压更低。此外，SR患者在PA和左心房压力降低方面比AF患者更有利。
