[二尖瓣形态对二尖瓣狭窄患者经皮气球二尖瓣成形术短期和长期预后的影响]

[The impact of mitral valve morphology on the short and long-term outcome post percutaneous balloon mitral valvuloplasty in patients with mitral valve stenosis].

作者信息

Zhang Ling, Wei Wei, Yue Xiu-yu, Shi Zhen-gang

机构信息

Department of Cardiology, Second People's Hospital of Pingdingshan, Pingdingshan 467000, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2011 Dec;39(12):1124-8.

PMID:22336506

Abstract

OBJECTIVE

To investigate the short and long-term outcome post percutaneous balloon mitral valvuloplasty (PBMV) in mitral valve stenosis patients with different mitral valve morphology.

METHODS

Mitral valve morphology was graded according to the Wilkins scoring system, 385 eligible patients were divided into echocardiographic scores > 8 group (n = 125) and ≤ 8 group (n = 260). Patients were followed up after PBMV according to the improved Inoue method.

RESULTS

PBMV was successful in 370 patients, the success rate of PBMV in > 8 group was significantly lower than in ≤ 8 group (92.8% vs. 97.7%, P < 0.05). Hemodynamic parameters improved significantly in both groups (all P < 0.05) at 6 months post PBMV. Compared to pre-PBMV, improvement on left atrial mean pressure [(14.22 ± 5.02) mm Hg vs. (15.44 ± 5.19) mm Hg (1 mm Hg = 0.133 kPa)], pulmonary artery systolic pressure [(26.13 ± 9.27) mm Hg vs. (31.93 ± 9.98) mm Hg], mitral valve gradient [(9.21 ± 4.11) mm Hg vs. (10.16 ± 4.21) mm Hg] and area of mitral valve orifice [(1.02 ± 0.15) cm(2) vs. (1.20 ± 0.22) cm(2)] post PBMV was less in > 8 group (116 cases) than those in ≤ 8 group (254 cases, all P < 0.05). Three hundreds and fifty three patients were followed up for (78 ± 20) months. Echocardiographic parameters post PBMV improved significantly in both groups compared with the pre-PBMV values during follow-up (all P < 0.05). However, left atrial mean pressure, pulmonary artery systolic pressure, mitral valve gradient and area of mitral valve orifice in > 8 group (108 cases) improved less than those in ≤ 8 group (245 cases) [(13.28 ± 5.06) mm Hg vs. (14.77 ± 5.17) mm Hg, (21.19 ± 9.17) mm Hg vs. (28.92 ± 9.91) mm Hg, (7.30 ± 4.40) mm Hg vs. (9.16 ± 4.28) mm Hg, (0.92 ± 0.17) cm(2) vs. (1.07 ± 0.20) cm(2); all P < 0.05]. The incidence of mitral restenosis was also significantly higher in > 8 group than in ≤ 8 group (20.4% vs. 8.2%, P < 0.05).

CONCLUSIONS

The mitral valve morphology played a key role on the outcome post PBMV in patients with mitral valve stenosis. Patients with lower echocardiographic scores benefit more from PBMV than patients with higher echocardiographic scores.

摘要

目的

探讨不同二尖瓣形态的二尖瓣狭窄患者经皮二尖瓣球囊成形术（PBMV）的近期和远期疗效。

方法

根据威尔金斯评分系统对二尖瓣形态进行分级，385例符合条件的患者分为超声心动图评分>8分组（n = 125）和≤8分组（n = 260）。采用改良的井上法对患者进行PBMV术后随访。

结果

370例患者PBMV成功，>8分组的PBMV成功率显著低于≤8分组（92.8%对97.7%，P < 0.05）。PBMV术后6个月时，两组患者的血流动力学参数均显著改善（均P < 0.05）。与PBMV术前相比，>8分组（116例）PBMV术后左房平均压[（14.22±5.02）mmHg对（15.44±5.19）mmHg（1mmHg = 0.133kPa）]、肺动脉收缩压[（26.13±9.27）mmHg对（31.93±9.98）mmHg]、二尖瓣跨瓣压差[（9.21±4.11）mmHg对（10.16±4.21）mmHg]及二尖瓣口面积[（1.02±0.15）cm²对（1.20±0.22）cm²]的改善程度均小于≤8分组（254例，均P < 0.05）。353例患者随访（78±20）个月。随访期间，两组患者PBMV术后的超声心动图参数与术前相比均显著改善（均P < 0.05）。然而，>8分组（108例）的左房平均压、肺动脉收缩压、二尖瓣跨瓣压差及二尖瓣口面积的改善程度小于≤8分组（245例）[（13.28±5.06）mmHg对（14.77±5.17）mmHg，（21.19±9.17）mmHg对（28.92±9.91）mmHg，（7.30±4.40）mmHg对（9.16±4.28）mmHg，（0.92±0.17）cm²对（1.07±0.20）cm²；均P < 0.05]。>8分组的二尖瓣再狭窄发生率也显著高于≤8分组（20.4%对8.2%，P < 0.05）。