Eltchaninoff Hélène, Tron Christophe, Cribier Alain
Department of Cardiology, Charles Nicolle Hospital, University of Rouen, Rouen, France.
Am J Cardiol. 2003 Feb 15;91(4):425-8. doi: 10.1016/s0002-9149(02)03237-x.
Balloon mitral valvuloplasty has been reported to give equal or less positive results after previous commissurotomy than after a first procedure. Percutaneous mechanical mitral commissurotomy (PMMC) is a new technique that has not yet been evaluated in this subset of patients. Of 1,175 PMMC procedures (1,175 patients), 173 patients (14.7%) had previous commissurotomy; patients were older (40 vs 35 years of age, p <0.0001) and more often in atrial fibrillation (34% vs 21%, p = 0.0016) than were patients who had not undergone previous commissurotomy. The baseline transmitral gradient was lower (17 +/- 8 vs 19 +/- 8 mm Hg, p <0.002) and the echocardiographic Wilkins score was higher (8.7 +/- 1.9 vs 7.6 +/- 1.8, p <0.0001) for patients who underwent previous commissurotomy. Baseline mitral valve area was comparable between the 2 groups (0.96 +/- 0.21 vs 0.93 +/- 0.24 cm(2)). Immediate results were satisfactory, although slightly less favorable after previous commissurotomy, with a final mitral valve area of 2.01 +/- 0.30 versus 2.12 +/- 0.36 cm(2) (p <0.0001), and a residual transvalvular gradient of 5.0 +/- 3.6 versus 4.2 +/- 4.1 mm Hg (p = 0.003). The rates of procedural success (93%) and severe complications (4.7%) were comparable between the 2 groups. Thus, PMMC is an effective and safe technique for the treatment of mitral restenosis after previous commissurotomy.
据报道，与首次进行球囊二尖瓣成形术相比，二尖瓣交界切开术后再行该手术的阳性结果相同或更少。经皮机械性二尖瓣交界切开术（PMMC）是一种新技术，尚未在这部分患者中进行评估。在1175例PMMC手术（1175例患者）中，173例患者（14.7%）曾接受过交界切开术；与未接受过交界切开术的患者相比，这些患者年龄更大（40岁对35岁，p<0.0001），房颤发生率更高（34%对21%，p = 0.0016）。曾接受过交界切开术的患者基线二尖瓣跨瓣压差更低（17±8对19±8 mmHg，p<0.002），超声心动图Wilkins评分更高（8.7±1.9对7.6±1.8，p<0.0001）。两组患者的基线二尖瓣瓣口面积相当（0.96±0.21对0.93±0.24 cm²）。即时结果令人满意，尽管曾接受过交界切开术的患者结果略逊一筹，最终二尖瓣瓣口面积为2.01±0.30对2.12±0.36 cm²（p<0.0001），残余跨瓣压差为5.0±3.6对4.2±4.1 mmHg（p = 0.003）。两组的手术成功率（93%）和严重并发症发生率（4.7%）相当。因此，PMMC是治疗二尖瓣交界切开术后二尖瓣再狭窄的一种有效且安全的技术。
