经皮球囊瓣膜成形术后二尖瓣会回弹吗？

Does the mitral valve recoil after percutaneous balloon valvotomy?

作者信息

Karthikeyan Ganesan, Yadav Rakesh, Narang Rajiv, Bhargava Balram

机构信息

Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.

出版信息

Cardiovasc Revasc Med. 2011 May-Jun;12(3):147-151. doi: 10.1016/j.carrev.2010.04.001. Epub 2010 Oct 20.

DOI:10.1016/j.carrev.2010.04.001

PMID:21640932

Abstract

AIM

The significance of passive stretching of the mitral valve as a contributor to valve opening, after percutaneous transvenous mitral commissurotomy (PTMC), is not known. Our objective was to determine whether any acute reduction in valve area occurs due to recoil of stretched valve structures.

METHODS AND RESULTS

In a prospective observational study, we evaluated nine patients (age 30.1±8.0 years; median valve score 7) who underwent PTMC. We calculated mitral valve area (MVA) before, immediately after, and at 10 and 30 min after valvotomy. There was no acute reduction in MVA after successful PTMC. But there was a significant increase in MVA at 30 min, from that measured immediately after the procedure (1.8±0.4 to 2.0±0.4 cm(2); P=.048). This was attributable to the continuing fall in pulmonary artery wedge (PAW) pressures (17±3 to 15±3 mmHg; P=.003) and transmitral gradients (8±3 to 7±2 mmHg; P=.037).

CONCLUSION

Passive stretching of the valve apparatus does not play an important role in valve opening after PTMC in young patients with favorable valve morphology.

摘要

目的

经皮经静脉二尖瓣交界切开术（PTMC）后，二尖瓣被动伸展作为瓣膜开放的一个促成因素的意义尚不清楚。我们的目的是确定瓣膜结构伸展后的回弹是否会导致瓣膜面积的任何急性减小。

方法和结果

在一项前瞻性观察研究中，我们评估了9例接受PTMC的患者（年龄30.1±8.0岁；瓣膜评分中位数为7）。我们计算了瓣膜切开术前、术后即刻以及术后10分钟和30分钟时的二尖瓣面积（MVA）。成功的PTMC术后MVA没有急性减小。但术后30分钟时MVA较术后即刻显著增加（从1.8±0.4增加至2.0±0.4 cm²；P = 0.048）。这归因于肺动脉楔压（PAW）持续下降（从17±3降至15±3 mmHg；P = 0.003）以及跨二尖瓣压差（从8±3降至7±2 mmHg；P = 0.037）。