Ishihara H, Hamanaka Y, Sueda T, Kanehiro K, Shikata H, Matsuura Y, Matsuura H, Okamoto M, Tsuchioka Y, Nakagawa H
First Department of Surgery, Hiroshima University School of Medicine.
J Cardiol. 1991;21(4):943-9.
From April 1987 to October 1989, 32 patients with mitral stenosis (MS) were treated, of whom percutaneous transvenous mitral commissurotomy (PTMC) was performed in 14. PTMC was indicated by the surgeons in 5 patients including 1) 2 patients who refused reoperation, 2) one with early gastric cancer, 3) one with severe hyperthyroidism and cardiac cachexia, and 4) one with acute renal failure and aortic stenosis. In the other 9 patients, PTMC was indicated by the cardiologists, because it is less invasive. Thirteen patients underwent open mitral commissurotomy (OMC) and 5 patients were treated with mitral valve replacement (MVR). PTMC group: Symptoms were alleviated in 10 of 14. The mitral valve areas (MVA) changed from 1.03 +/- 0.47 cm2 to 1.90 +/- 0.67 cm2 (p < 0.001), and the mean pressure gradient between the left atrium and left ventricle decreased from 10.2 +/- 3.6 mmHg to 4.9 +/- 1.7 mmHg (p < 0.001). No significant mitral valve regurgitation (MR) was induced by PTMC. OMC group: Symptomatic improvement was observed in all patients. The MVA changed from 1.54 +/- 0.46 cm2 to 3.06 +/- 1.34 cm2 (p < 0.001) and the mean left atrial pressures were reduced from 17.6 +/- 7.8 mmHg to 10.5 +/- 4.2 mmHg (p < 0.001). MVR group: There was one hospital death, and the other 4 patients were discharged with satisfactory results. It is concluded that although PTMC has been routinely performed for mild cases, this method is also very helpful in treating patients having various complications which impede open heart surgery.
1987年4月至1989年10月，对32例二尖瓣狭窄（MS）患者进行了治疗，其中14例行经皮经静脉二尖瓣交界切开术（PTMC）。外科医生认为5例患者适合行PTMC，包括：1）2例拒绝再次手术的患者；2）1例患有早期胃癌的患者；3）1例患有严重甲状腺功能亢进和心脏恶病质的患者；4）1例患有急性肾衰竭和主动脉狭窄的患者。在另外9例患者中，心脏病专家认为适合行PTMC，因为其侵入性较小。13例患者接受了直视二尖瓣交界切开术（OMC），5例患者接受了二尖瓣置换术（MVR）。PTMC组：14例中有10例症状得到缓解。二尖瓣瓣口面积（MVA）从1.03±0.47cm²变为1.90±0.67cm²（p<0.001），左心房与左心室之间的平均压力梯度从10.2±3.6mmHg降至4.9±1.7mmHg（p<0.001）。PTMC未诱发明显的二尖瓣反流（MR）。OMC组：所有患者症状均有改善。MVA从1.54±0.46cm²变为3.06±1.34cm²（p<0.001），平均左心房压力从17.6±7.8mmHg降至10.5±4.2mmHg（p<0.001）。MVR组：有1例患者住院死亡，其他4例患者出院时效果满意。结论是，虽然PTMC通常用于轻症患者，但该方法对于治疗有各种妨碍心脏直视手术并发症的患者也非常有帮助。
