经皮二尖瓣交界分离术：超声心动图评估对即刻结果预测的意义。

Percutaneous transvenous mitral commissurotomy: significance of echocardiographic assessment in prediction of immediate result.

机构信息

Echocardiography Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.

出版信息

Arch Iran Med. 2012 Oct;15(10):629-34.

PMID:23020539

Abstract

BACKGROUND

The current study aims to identify demographic, clinical characteristics, echocardiographic and/or mitral valve morphological parameters that may predict the successful result of percutaneous transvenous mitral commissurotomy (PTMC).

METHODS

The medical records of 196 patients (48 males, mean age: 42.7 ± 11.5 years) who underwent PTMC were reviewed. Prior to PTMC, a combination of transthoracic and transesophageal echocardiography were used to investigate substantial mitral valve morphological subcomponents (thickening, mobility, calcification, and subvalvular thickness) and suitability for PTMC. The second transthoracic echocardiographic assessment was performed within six weeks after PTMC. Patients were divided into two categories of successful or unsuccessful according to PTMC results. Successful PTMC was defined as: final mitral valve area (MVA) ≥1.5 cm2 without a post-procedure mitral regurgitation (MR) grade >2. The significant predictor of the result was identified by comparing demographic data, initial echocardiographic assessments and mitral valve morphological scores within both groups.

RESULTS

The mean MVA increased from 1.0 ± 0.2 cm2 to 1.7 ± 0.4 cm2, and mitral valve mean gradient (MVMG) decreased from 11.5 ± 5.2 to 5.2 ± 3.3 mmHg (P < 0.001 for both). Successful results were obtained in 139 (70.9%) patients compared to unsuccessful results in 57 (29.1%). Unsuccessful results were due to suboptimal secondary MVA < 1.5 cm2 in 50 (25.5%) patients and post-procedure MR grade >2 in 7 (3.6%). Multiple logistic regression analysis indicated that young age, lower size of the left atrium (LA), and smaller degree of mitral valve thickness were the predictors of successful result.

CONCLUSION

Pre-procedure echocardiographic assessment appears to be helpful in predicting PTMC results. Successful PTMC is influenced by the patients' age, LA size, and mitral valve thickness.

摘要

背景

本研究旨在确定人口统计学、临床特征、超声心动图和/或二尖瓣形态参数，这些参数可能预测经皮经静脉二尖瓣交界分离术（PTMC）的成功结果。

方法

回顾了 196 名接受 PTMC 治疗的患者（48 名男性，平均年龄：42.7±11.5 岁）的病历。在进行 PTMC 之前，通过经胸超声心动图和经食管超声心动图联合检查来评估二尖瓣形态的实质性亚组分（增厚、活动度、钙化和瓣下厚度）以及是否适合进行 PTMC。PTMC 后 6 周内进行第二次经胸超声心动图评估。根据 PTMC 结果将患者分为成功和不成功两组。成功的 PTMC 定义为：最终二尖瓣面积（MVA）≥1.5cm2，且术后二尖瓣反流（MR）分级≤2 级。通过比较两组之间的人口统计学数据、初始超声心动图评估和二尖瓣形态评分，确定结果的显著预测因子。

结果

MVA 从 1.0±0.2cm2 增加到 1.7±0.4cm2，二尖瓣平均梯度（MVMG）从 11.5±5.2mmHg 降低到 5.2±3.3mmHg（两者均 P＜0.001）。139 例（70.9%）患者获得成功结果，57 例（29.1%）患者结果不理想。不理想的结果是由于次要 MVA＜1.5cm2 的有 50 例（25.5%）患者和术后 MR 分级＞2 级的有 7 例（3.6%）患者。多因素逻辑回归分析表明，年龄较小、左心房（LA）较小、二尖瓣厚度较小是成功结果的预测因素。