Ullah Maad, Sultan Mehboob, Akbar Hajira, Sadiq Nadeem
Department of Pediatric Cardiology, Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, Pakistan.
Pediatr Cardiol. 2012 Jun;33(5):814-7. doi: 10.1007/s00246-012-0191-1. Epub 2012 Feb 15.
We report a 5-year-old boy weighing 11 kg, with severe mitral valve stenosis of rheumatic aetiology, who underwent successful percutaneous transluminal mitral commissurotomy (PTMC) with valvuloplasty balloon. Postprocedural mean pressure gradient across the mitral valve decreased to 6 mmHg from an initially recorded value of 22 mmHg. In addition to symptomatic improvement, the mitral valvular area increased from 0.4 to 0.8 cm(2) without significant change in mitral regurgitation. At 1- and 3-month follow up, transthoracic echocardiography revealed further improvement with an increase in mitral valve area to 1.0 cm(2), a decrease in pulmonary arterial pressure, and a mean mitral valve pressure gradient of 8 mmHg with trivial mitral regurgitation. To best of our knowledge, this is the first successful PTMC procedure performed in the youngest and smallest ever reported child with rheumatic mitral stenosis (MS). We conclude that PTMC with valvuloplasty balloon could be a logical alternative to surgery in young patients with rheumatic MS.
我们报告了一名5岁男孩，体重11公斤，患有风湿性病因导致的严重二尖瓣狭窄，他接受了经皮球囊二尖瓣交界切开术（PTMC）并使用了瓣膜成形球囊，手术成功。术后二尖瓣跨瓣平均压差从最初记录的22 mmHg降至6 mmHg。除了症状改善外，二尖瓣瓣口面积从0.4增加到0.8 cm²，二尖瓣反流无明显变化。在1个月和3个月的随访中，经胸超声心动图显示进一步改善，二尖瓣瓣口面积增加到1.0 cm²，肺动脉压降低，二尖瓣平均压差为8 mmHg，二尖瓣反流轻微。据我们所知，这是有史以来报道的最年轻、最小的风湿性二尖瓣狭窄（MS）患儿首次成功进行的PTMC手术。我们得出结论，对于患有风湿性MS的年轻患者，经皮球囊二尖瓣交界切开术联合瓣膜成形球囊可能是手术的合理替代方案。
