Jneid Hani, Cruz-Gonzalez Ignacio, Sanchez-Ledesma María, Maree Andrew O, Cubeddu Roberto J, Leon Milton L, Rengifo-Moreno Pablo, Otero Juan Pal, Inglessis Ignacio, Sanchez Pedro L, Palacios Igor F
Section of Cardiology, Department of Medicine, Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, Texas, USA.
Am J Cardiol. 2009 Oct 15;104(8):1122-7. doi: 10.1016/j.amjcard.2009.06.008. Epub 2009 Aug 28.
Percutaneous mitral valvuloplasty (PMV) is an effective therapy in patients with significant mitral stenosis. Few studies have examined the effect of mitral regurgitation (MR), a frequent periprocedural finding, on PMV outcomes. We examined the effects of pre- and postprocedural MR after PMV. Contrast left ventriculography was performed before and after PMV, and the MR severity was assessed using Sellers' classification. Clinical, hemodynamic, and morphologic variables were collected for all patients. Consecutive patients (n = 876) undergoing a first PMV procedure at a single tertiary center were evaluated. An increasing preprocedural MR severity was associated with reduced PMV success (no MR, 75%; 1+ MR, 65%; 2+ MR, 44%; p <0.0001), increased in-hospital mortality (0.6% vs 2.8% vs 4.9%, respectively; p = 0.007), and other complications. Increasing grades of pre- and postprocedural MR predicted, independently and in a grade-dependent manner, the composite outcome of mortality, mitral valve surgery, or redo PMV (preprocedural MR >or=1+, relative risk [RR] 1.4, 95% confidence interval [CI] 1.2 to 1.8; preprocedural MR >or=2+, RR 1.6, 95% CI 1.1 to 2.4; postprocedural MR >or=1+, RR 1.6, 95% CI 1.2 to 2.0; postprocedural MR >or=2+, RR 2.2, 95% CI 1.7 to 2.7; and postprocedural MR >or=3+, RR 4.6, 95% CI 3.4 to 6.2, respectively). In conclusion, increasing pre- and postprocedural MR grades independently predicted the long-term clinical outcomes after PMV. Patients with moderate preprocedural MR, in particular, appeared to have suboptimal short- and long-term outcomes, necessitating careful monitoring and early referral for mitral valve surgery, when appropriate.
经皮二尖瓣球囊成形术（PMV）是重度二尖瓣狭窄患者的一种有效治疗方法。很少有研究探讨二尖瓣反流（MR）这一围手术期常见发现对PMV疗效的影响。我们研究了PMV术前和术后MR的影响。在PMV前后进行对比左心室造影，并使用塞勒斯分类法评估MR严重程度。收集所有患者的临床、血流动力学和形态学变量。对在单一三级中心接受首次PMV手术的连续患者（n = 876）进行评估。术前MR严重程度增加与PMV成功率降低相关（无MR，75%；1+级MR，65%；2+级MR，44%；p<0.0001），住院死亡率增加（分别为0.6%、2.8%和4.9%；p = 0.007）以及其他并发症。术前和术后MR分级增加以分级依赖的方式独立预测了死亡率、二尖瓣手术或再次PMV的复合结局（术前MR≥1+，相对风险[RR]1.4，95%置信区间[CI]1.2至1.8；术前MR≥2+，RR 1.6，95%CI 1.1至2.4；术后MR≥1+，RR 1.6，95%CI 1.2至2.0；术后MR≥2+RR 2.2，95%CI 1.7至2.7；术后MR≥3+，RR 4.6，95%CI 3.4至6.2）。总之，术前和术后MR分级增加独立预测了PMV后的长期临床结局。尤其是术前中度MR的患者，其短期和长期结局似乎欠佳，需要仔细监测，并在适当时尽早转诊进行二尖瓣手术。
