Cianciulli Tomás F, Saccheri María C, Lax Jorge A, Sarmiento Ricardo A, Bermann Alejandra M, Gagliardi Juan A, Cirio Juan J, Dorelle Adriana N, Prezioso Horacio A, Vidal Luis A
Division of Cardiology, Hospital del Gobierno de la Ciudad de Buenos Aires Dr. Cosme Argerich, Buenos Aires, Argentina.
J Heart Valve Dis. 2008 Sep;17(5):492-500.
Percutaneous mitral valvuloplasty (PMV) is an effective method for treating patients with severe mitral stenosis. The study aim was to compare left and right atrial appendage functions before and after PMV.
Twenty-five patients (23 women, two men; mean age 38 +/- 9 years; range: 21-57 years) with severe mitral stenosis and sinus rhythm who underwent PMV were included in the study. Transesophageal echocardiography (TEE) was performed before and at six months after PMV, to evaluate the intensity of spontaneous echo contrast (SEC), left atrial appendage (LAA) dimensions and function, and right atrial appendage (RAA) function.
After PMV, the SEC (at TEE) was decreased in all patients, while increases were observed in the contraction and relaxation velocity flows of the LAA (pre-PMV 18 +/- 5 cm/s; post-PMV 24 +/- 9 cm/s; p < 0.001 and pre-PMV 25.5 +/- 10.2 cm/s; post-PMV 32.9 +/- 12.6 cm/s; p < 0.006, respectively). The tissue myocardial velocities were also increased in the LAA (pre-PMV 6.92 +/- 3.77 cm/s; post-PMV 11.16 +/- 6.61 cm/s; p < 0.002) and RAA (pre-PMV 16.2 +/- 3.7 cm/s; post-PMV 19.1 +/- 4.1 cm/s; p < 0.001).
In patients with mitral stenosis and sinus rhythm, improvements were noted in the left atrial, LAA and RAA systolic functions after PMV. This suggests that the relief of mitral stenosis may not only confer hemodynamic benefits to improve symptoms but also have a favorable influence on future thromboembolic complications. Thus, an early intervention might benefit patients with sinus rhythm by preventing the development of atrial fibrillation and systemic and pulmonary embolism.
经皮二尖瓣球囊成形术（PMV）是治疗重度二尖瓣狭窄患者的有效方法。本研究旨在比较PMV术前和术后左、右心耳功能。
本研究纳入25例重度二尖瓣狭窄且为窦性心律并接受PMV的患者（23例女性，2例男性；平均年龄38±9岁；范围：21 - 57岁）。在PMV术前及术后6个月进行经食管超声心动图（TEE）检查，以评估自发回声增强（SEC）的强度、左心耳（LAA）的大小和功能以及右心耳（RAA）的功能。
PMV术后，所有患者的SEC（TEE检查时）均降低，而LAA的收缩和舒张速度血流增加（PMV术前18±5 cm/s；PMV术后24±9 cm/s；p<0.001；PMV术前25.5±10.2 cm/s；PMV术后32.9±12.6 cm/s；p<0.006）。LAA和RAA的组织心肌速度也增加（LAA：PMV术前6.92±3.77 cm/s；PMV术后11.16±6.61 cm/s；p<0.002；RAA：PMV术前16.2±3.7 cm/s；PMV术后19.1±4.1 cm/s；p<0.001）。
在二尖瓣狭窄且为窦性心律的患者中，PMV术后左心房、LAA和RAA的收缩功能有所改善。这表明二尖瓣狭窄的解除不仅可能带来血流动力学益处以改善症状，还可能对未来的血栓栓塞并发症产生有利影响。因此，早期干预可能通过预防房颤以及全身和肺栓塞的发生，使窦性心律患者受益。
