经皮经静脉二尖瓣交界切开术与直视二尖瓣交界切开术对比

[Percutaneous transvenous, mitral commissurotomy versus open mitral commissurotomy].

作者信息

Momomura S, Takenaka K, Serizawa T, Chikada M, Kotsuka H, Matsunoga H, Furuse A

机构信息

Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan.

出版信息

Nihon Geka Gakkai Zasshi. 1992 Sep;93(9):1016-9.

PMID:1470107

Abstract

Effects of PTMC (percutaneous transvenous mitral commissurotomy) were evaluated retrospectively in 34 patients with mitral stenosis and compared with those of OMC (open mitral commissurotomy) in 28 patients. PTMC resulted in a decrease in transmitral pressure gradient from 11 +/- 6 to 6 +/- 4 mmHg (p < 0.001) and an increase in cardiac index from (2.4 +/- 0.4 to 2.7 +/- 0.5 L/min.m2 and mitral valve area from 1.0 +/- 0.3 to 1.7 +/- 0.4 cm2 (p < 0.001). Mitral valve area remained increased (1.6 +/- 0.4 cm2) after a mean follow-up period of 19 +/- 11 months. Death, cerebro-vascular accident, or sever mitral regurgitation (> III degrees) did not occur. NYHA class improved from 2.28 +/- 0.63 to 1.44 +/- 0.50 (p < 0.001). OMC resulted in a greater increase in mitral valve area (from 1.1 +/- 1.4 to 2.0 +/- 0.5 cm2, p < 0.001) and greater improvement of NYHA class (2.25 +/- 0.65 to 1.11 +/- 0.34, p < 0.001). Thus OMC surpasses PTMC in hemodynamic effects and symptomatic improvement. However, PTMC may still be the first choice for the treatment of mitral stenosis because of its excellent safety and efficacy.

摘要

对34例二尖瓣狭窄患者经皮经静脉二尖瓣交界切开术（PTMC）的效果进行回顾性评估，并与28例接受直视二尖瓣交界切开术（OMC）的患者进行比较。PTMC使二尖瓣跨瓣压差从11±6 mmHg降至6±4 mmHg（p<0.001），心脏指数从（2.4±0.4）升高至（2.7±0.5）L/min·m²，二尖瓣瓣口面积从1.0±0.3 cm²增加至1.7±0.4 cm²（p<0.001）。平均随访19±11个月后，二尖瓣瓣口面积仍维持在（1.6±0.4）cm²。未发生死亡、脑血管意外或严重二尖瓣反流（>Ⅲ度）。纽约心脏协会（NYHA）心功能分级从2.28±0.63改善至1.44±0.50（p<0.001）。OMC使二尖瓣瓣口面积增加更多（从1.1±1.4 cm²增至2.0±0.5 cm²，p<0.001），NYHA心功能分级改善更明显（从2.25±0.65改善至1.11±0.34，p<0.001）。因此，OMC在血流动力学效应和症状改善方面优于PTMC。然而，由于其出色的安全性和有效性，PTMC仍可能是二尖瓣狭窄治疗的首选。