同期经房间隔逆行 Inoue 球囊二尖瓣和主动脉瓣成形术。

Division of cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Cardiology Department, National Heart Institute, Cairo, Egypt.

Catheter Cardiovasc Interv. 2013 Nov 1;82(5):E712-7. doi: 10.1002/ccd.24770. Epub 2013 Feb 21.

BACKGROUND

The Inoue balloon has been in use for many years for mitral valvuloplasty. Aortic valvuloplasty using the Inoue balloon via transseptal approach was developed in the hope of providing better results with less potential vascular access complications.

METHODS AND RESULTS

In this study, we present our experience in percutaneous valvuloplasty using the Inoue balloon in 14 patients with combined rheumatic mitral and aortic stenosis (AS) in a single stage procedure via antegrade transseptal approach. The study group was characterized by relatively young age (mean 37.5 ± 9.6 years). Aortic followed by mitral valvuloplasty via antegrade approach resulted in a fall of transaortic peak pressure gradient (PG) from 59.1 ± 11.2 mm Hg to 25.3 ± 12.5 mm Hg (P = 0.012) and mean from 49.0 ± 10.9 mm Hg to 16.6 ± 9.8 mm Hg (P = 0.043). Aortic valve areas increased significantly from 0.70 ± 0.25 cm(2) to 1.41 ± 0.48 cm(2) (P = 0.042). Mean transmitral PG decreased from 14.9 ± 2.1 mm Hg to 5.3 ± 1.5 with increase of mitral valve areas from 1.08 ± 0.45 to 1.92 ± 0.51 cm(2). The procedures were well tolerated without development of significant valvular regurgitation or thromboembolism. During follow-up, 2 patients died due to lung cancer and sudden death at months 48 and 100. Five patients received delayed surgery after mean duration of 73.4 ± 39.7 months.

CONCLUSIONS

Concurrent antegrade, transseptal Inoue-balloon aortic and mitral valvuloplasty, is feasible and safe, and provides excellent immediate results as one-stage procedure. The study results also suggest that balloon aortic valvuloplasty can be more durable in younger patients with rheumatic AS than in elderly patients with degenerative, AS. However, the modified aortic valvuloplasty technique can be utilized only as bridging procedure to aortic valve replacement or recently developed transcatheter aortic-valve implantation in unstable hemodynamic status, and as a palliative procedure before noncardiac surgery.

背景

Inoue 球囊已应用于二尖瓣成形术多年。经房间隔途径行 Inoue 球囊主动脉瓣成形术，旨在提供更好的效果，同时减少潜在的血管入路并发症。

方法和结果

本研究中，我们介绍了经房间隔途径顺行入路在 14 例合并风湿性二尖瓣和主动脉瓣狭窄（AS）的患者中行经皮瓣成形术的经验。研究组的特点是年龄相对较轻（平均 37.5±9.6 岁）。经顺行途径行主动脉瓣成形术后再行二尖瓣成形术，跨主动脉瓣峰值压力梯度（PG）从 59.1±11.2mmHg 降至 25.3±12.5mmHg（P=0.012），平均 PG 从 49.0±10.9mmHg 降至 16.6±9.8mmHg（P=0.043）。主动脉瓣口面积显著增加，从 0.70±0.25cm²增加至 1.41±0.48cm²（P=0.042）。二尖瓣 PG 从 14.9±2.1mmHg 降至 5.3±1.5mmHg，同时二尖瓣口面积从 1.08±0.45cm²增加至 1.92±0.51cm²。手术耐受良好，无明显瓣膜反流或血栓栓塞发生。随访期间，2 例患者分别于术后 48 个月和 100 个月因肺癌和猝死死亡。5 例患者在平均 73.4±39.7 个月后行延迟手术。

结论

同期顺行、经房间隔 Inoue 球囊主动脉瓣和二尖瓣成形术是可行且安全的，作为一种单阶段手术可提供极好的即刻效果。研究结果还表明，与老年退行性 AS 患者相比，球囊主动脉瓣成形术在年轻风湿性 AS 患者中更持久。然而，改良的主动脉瓣成形术技术仅可作为不稳定血流动力学状态下主动脉瓣置换或最近开发的经导管主动脉瓣植入术的桥接术，以及非心脏手术前的姑息性手术。