Guérios Enio E, Bueno Ronaldo R L, Nercolini Deborah C, Tarastchuk José C E, Andrade Paulo M P, Pacheco Alvaro L A, Perreto Sônia
Interventional Cardiology Department, Hospital Universitário Evangélico, Curitiba, Brazil.
Catheter Cardiovasc Interv. 2005 Mar;64(3):301-11. doi: 10.1002/ccd.20262.
The metallic commissurotome (MC) technique is a cheaper alternative to the Inoue balloon (IB) technique for percutaneous mitral valvuloplasty (PMV). There are no randomized trials comparing these techniques with longer follow-up of the patients. The objective of this study was to compare the immediate results and short- and medium-term follow-up of PMV using either the IB or the MC technique. Fifty patients with rheumatic mitral stenosis were randomly assigned to PMV using the IB (n = 27) or the MC (n = 23) technique. There were no significant differences between the groups regarding baseline clinical, echocardiographic, and hemodynamic data. Clinical and echocardiographic follow-up were done 6 months and 3 years after the procedure. The success rate was 100% in the IB group and 91.3% in the MC group (P = 0.15); two patients in the latter group developed mitral regurgitation grade 3/4, requiring elective surgery. The mean final mitral valve area was bigger in the MC group (2.17 +/- 0.13 vs. 2.00 +/- 0.36 cm2; P = 0.04), but after 6-month and 3-year follow-up, this difference was no longer significant (2.06 +/- 0.27 vs. 1.98 +/- 0.38 cm2, P = 0.22, and 1.86 +/- 0.32 vs. 1.87 +/- 0.34 cm2, P = 0.89, respectively). This finding suggests valve stretching as an important mechanism of valve dilation with the MC. Three patients in the MC group and two patients in the IB group (P = 0.65) developed mitral valve restenosis; one of them underwent repeat PMV and the other four, all asymptomatic, were clinically followed. PMV performed either with the IB or the MC technique is effective and provides excellent short- and medium-term outcomes regardless of the technique employed.
对于经皮二尖瓣球囊成形术（PMV），金属瓣膜交界切开术（MC）技术是一种比井上球囊（IB）技术更便宜的替代方法。尚无随机试验对这些技术进行比较并对患者进行更长时间的随访。本研究的目的是比较使用IB技术或MC技术进行PMV的即刻结果以及短期和中期随访情况。50例风湿性二尖瓣狭窄患者被随机分配接受使用IB技术（n = 27）或MC技术（n = 23）的PMV。两组在基线临床、超声心动图和血流动力学数据方面无显著差异。在术后6个月和3年进行临床和超声心动图随访。IB组成功率为100%，MC组为91.3%（P = 0.15）；后一组中有2例患者出现3/4级二尖瓣反流，需要择期手术。MC组最终二尖瓣平均瓣口面积更大（2.17±0.13 vs. 2.00±0.36 cm²；P = 0.04），但在6个月和3年随访后，这种差异不再显著（分别为2.06±0.27 vs. 1.98±0.38 cm²，P = 0.22；以及1.86±0.32 vs. 1.87±0.34 cm²，P = 于0.89）。这一发现表明瓣膜伸展是MC瓣膜扩张的重要机制。MC组有3例患者和IB组有2例患者（P = 0.65）出现二尖瓣再狭窄；其中1例接受了再次PMV，另外4例均无症状，进行临床随访。无论采用哪种技术，使用IB或MC技术进行的PMV都是有效的，并且能提供良好的短期和中期结果。
