Shrivastava S, Mathur A, Dev V, Saxena A, Venugopal P, SampathKumar A
Department of Cardiology and Cardiovascular, All India Institute of Medical Sciences, New Delhi.
J Thorac Cardiovasc Surg. 1992 Nov;104(5):1264-7.
The hemodynamic response to closed mitral commissurotomy, single-balloon, and double-balloon mitral valvuloplasty was compared using 20 patients in each group. All patients had symptomatic rheumatic mitral stenosis with a mitral valve area < 1 cm2, without any left atrial clot, mitral valve calcification, or mitral regurgitation. There was a significant improvement in hemodynamics following intervention in all three groups. The mean pulmonary artery pressure decreased from 49.1 +/- 17.5 to 28.6 +/- 8.3 mm Hg (p < 0.001), 48.8 +/- 12.3 to 34.0 +/- 13.9 mm Hg (p < 0.001), and 46.7 +/- 18.0 to 26.3 +/- 13.7 mm Hg (p < 0.001) in the closed mitral commissurotomy, single-balloon, and double-balloon mitral valvuloplasty groups, respectively. The mitral valve area increased from 0.62 +/- 0.27 to 1.5 +/- 0.5 cm2 (p < 0.001), 0.68 +/- 0.24 to 1.5 +/- 0.4 cm2 (p < 0.001), and 0.68 +/- 0.25 to 1.9 +/- 0.8 cm2 (p < 0.001) in the closed mitral commissurotomy, single-balloon, and double-balloon mitral valvuloplasty groups, respectively. The increase in the mitral valve area was maximum in the group with double-balloon mitral valvuloplasty. In the closed mitral commissurotomy group there was a significant rise in left ventricular end-diastolic pressure, from 6.8 +/- 3.9 to 9.3 +/- 3.1 mm Hg (p < 0.001), but this remained unchanged in the single-balloon and double-balloon mitral valvuloplasty groups. Our study shows that single-balloon and double-balloon mitral valvuloplasty are comparable to closed mitral commissurotomy in the immediate hemodynamic response, with a larger valve area in the double-balloon mitral valvuloplasty group.
对每组20例患者进行了比较，观察了闭式二尖瓣交界分离术、单球囊和双球囊二尖瓣成形术的血流动力学反应。所有患者均有症状性风湿性二尖瓣狭窄，二尖瓣面积<1平方厘米，无左心房血栓、二尖瓣钙化或二尖瓣反流。三组干预后血流动力学均有显著改善。闭式二尖瓣交界分离术组、单球囊二尖瓣成形术组和双球囊二尖瓣成形术组的平均肺动脉压分别从49.1±17.5降至28.6±8.3毫米汞柱（p<0.001）、从48.8±12.3降至34.0±13.9毫米汞柱（p<0.001）和从46.7±18.0降至26.3±13.7毫米汞柱（p<0.001）。闭式二尖瓣交界分离术组、单球囊二尖瓣成形术组和双球囊二尖瓣成形术组的二尖瓣面积分别从0.62±0.27增加至1.5±0.5平方厘米（p<0.001）、从0.68±0.24增加至1.5±0.4平方厘米（p<0.001）和从0.68±0.25增加至1.9±0.8平方厘米（p<0.001）。双球囊二尖瓣成形术组二尖瓣面积增加最大。闭式二尖瓣交界分离术组左心室舒张末期压力显著升高，从6.8±3.9升至9.3±3.1毫米汞柱（p<0.001），但单球囊和双球囊二尖瓣成形术组该指标保持不变。我们的研究表明，单球囊和双球囊二尖瓣成形术在即时血流动力学反应方面与闭式二尖瓣交界分离术相当，双球囊二尖瓣成形术组的瓣膜面积更大。
