Boscarini M, Repetto S, Cecchin G, Stifani A, Macchi G, Morandi F, Limido A, Binaghi G
Centro Cardiologico Donatelli, Varese.
G Ital Cardiol. 1991 Nov;21(11):1185-94.
31 symptomatic patients with mitral stenosis were selected for percutaneous transvenous mitral commissurotomy using Inoue catheter. The patients were selected using the echocardiographic score for: leaflets mobility, leaflets thickening, subvalvular thickening, degree of calcifications. All patients had a score less than or equal to 8 and represented 17.5% of the patients studied in our echocardiographic laboratory for mitral stenosis. We were able to perform the commissurotomy in 30 of them. Mean left atrial pressure decreased from 26 +/- 5.2 mmHg to 14.6 +/- 6 mmHg (p less than 0.001). The mean mitral diastolic pressure gradient decreased from 8.9 +/- 3.1 mmHg to 3.9 +/- 1.3 mmHg (p less than 0.001). The mitral valve area, using the echocardiographic Pressure Half Time (PHT), increased from 0.94 +/- 0.17 cmq to 1.96 +/- 0.33 cmq (p less than 0.001). Mitral regurgitation, angiographically evaluated in 29 patients, increased in 11 (38%), being of degree + + + in 3 patients. There were 2 heart tamponades and 5 cases (16.6%) of left-to-right shunt with Qp / Qs less than 2. After 3 months, the follow-up showed improvement of one or more functional classes in 96.6% of all patients. The mitral valve area, determined after 6 months in 24 patients by PHT, was stable (1.98 +/- 0.31 vs 1.93 +/- 0.25) (p = 0.5); we did not find mitral stenosis recurrence in any instance. In the first 10 patients, after 1 year, the results are stable (1.85 +/- 0.28 cmq vs 1.93 +/- 0.21 cmq) (p = 0.5) without mitral stenosis recurrence. These data suggest that in selected tight mitral stenosis the percutaneous transvenous commissurotomy may be alternative to the open surgical solution. Using an Inoue catheter, the percutaneous transvenous mitral commissurotomy is easier and the complications are few. The major procedural hazards derive from the transseptal technique.
选取31例有症状的二尖瓣狭窄患者，采用Inoue导管行经皮经静脉二尖瓣交界切开术。根据超声心动图评分选择患者，评分指标包括：瓣叶活动度、瓣叶增厚程度、瓣下增厚程度、钙化程度。所有患者评分均小于或等于8分，占我们超声心动图实验室研究的二尖瓣狭窄患者的17.5%。其中30例患者成功进行了交界切开术。平均左心房压力从26±5.2 mmHg降至14.6±6 mmHg（p<0.001）。二尖瓣舒张期平均压力阶差从8.9±3.1 mmHg降至3.9±1.3 mmHg（p<0.001）。采用超声心动图压力减半时间（PHT）法测得的二尖瓣瓣口面积从0.94±0.17 cm²增至1.96±0.33 cm²（p<0.001）。对29例患者进行血管造影评估二尖瓣反流情况，其中11例（38%）反流加重，3例为+++级。发生2例心包填塞，5例（16.6%）出现左向右分流，肺循环血流量与体循环血流量比值（Qp/Qs）小于2。3个月后随访显示，所有患者中96.6%的患者心功能分级改善一级或更多。24例患者在6个月后采用PHT法测定二尖瓣瓣口面积，结果稳定（1.98±0.31 vs 1.93±0.25）（p = 0.5）；未发现二尖瓣狭窄复发情况。前10例患者在1年后结果稳定（1.85±0.28 cm² vs 1.93±0.21 cm²）（p = 0.5），无二尖瓣狭窄复发。这些数据表明，对于经选择的重度二尖瓣狭窄患者，经皮经静脉二尖瓣交界切开术可能是开胸手术的替代方案。使用Inoue导管进行经皮经静脉二尖瓣交界切开术操作更简便，并发症少。主要的手术风险源于经房间隔技术。
