Ates Azman, Unlü Yahya, Yekeler Ibrahim, Erkut Bilgehan, Balci Ahmet Yavuz, Ozyazicioglu Ahmet, Koçak Hikmet
Department of Cardiovascular Surgery, Atatürk University School of Medicine, Erzurum, Turkey.
Heart Surg Forum. 2005;8(1):E55-9. doi: 10.1532/HSF98.20041137.
To evaluate long-term survival and valve-related complications as well as prognostic factors for mid- and long-term outcome after closed mitral commissurotomy, covering a follow-up period of 14 years.
Between 1989 and 2003, 36 patients (28 women and 8 men, mean age 28.8 +/- 6.1 years) underwent closed mitral commissurotomy at our institution. The majority of patients were in New York Heart Association (NYHA) functional class IIB, III, or IV. Indication for closed mitral commissurotomy was mitral stenosis. Closed mitral commissurotomy was undertaken with a Tubbs dilator in all cases. Median operating time was 2.5 hours +/- 30 minutes.
After closed mitral commissurotomy, the mitral valve areas of these patients were increased substantially, from 0.9 to 2.11 cm(2). No further operation after initial closed mitral commissurotomy was required in 86% of the patients (n = 31), and NYHA functional classification was improved in 94% (n = 34). Postoperative complications and operative mortality were not seen. Follow-up revealed restenosis in 8.5% (n = 3) of the patients, minimal mitral regurgitation in 22.2% (n = 8), and grade >or=3 mitral regurgitation in 5.5% (n = 2) patients. No early mortality occurred in closed mitral commissurotomy patients. Reoperation was essential for 5 patients following closed mitral commissurotomy; 2 procedures were open mitral commissurotomies and 3 were mitral valve replacements. No mortality occurred in these patients.
The mitral valve area was significantly increased and the mean mitral valve gradient was reduced in patients after closed mitral commissurotomy. Closed mitral commissurotomy is a safe alternative to open mitral commissurotomy and balloon mitral commissurotomy in selected patients.
评估闭式二尖瓣交界切开术后的长期生存率、瓣膜相关并发症以及中长期预后的预测因素，随访期长达14年。
1989年至2003年期间，我院36例患者（28例女性，8例男性，平均年龄28.8±6.1岁）接受了闭式二尖瓣交界切开术。大多数患者处于纽约心脏协会（NYHA）心功能IIB级、III级或IV级。闭式二尖瓣交界切开术的适应症为二尖瓣狭窄。所有病例均采用Tubbs扩张器进行闭式二尖瓣交界切开术。中位手术时间为2.5小时±30分钟。
闭式二尖瓣交界切开术后，这些患者的二尖瓣瓣口面积显著增加，从0.9增加至2.11平方厘米。86%（n = 31）的患者在初次闭式二尖瓣交界切开术后无需进一步手术，94%（n = 34）的患者NYHA心功能分级得到改善。未观察到术后并发症及手术死亡率。随访发现8.5%（n = 3）的患者出现再狭窄，22.2%（n = 8）的患者有轻度二尖瓣反流，5.5%（n = 2）的患者有≥3级二尖瓣反流。闭式二尖瓣交界切开术患者未发生早期死亡。5例患者在闭式二尖瓣交界切开术后需要再次手术；2例为开放式二尖瓣交界切开术，3例为二尖瓣置换术。这些患者均未发生死亡。
闭式二尖瓣交界切开术后患者的二尖瓣瓣口面积显著增加，平均二尖瓣跨瓣压差降低。对于部分患者，闭式二尖瓣交界切开术是开放式二尖瓣交界切开术和经皮球囊二尖瓣交界切开术之外的安全选择。
