Cardiology Department, AP-HP, Bichat University Hospital, Paris, France.
Heart. 2013 Sep;99(18):1336-41. doi: 10.1136/heartjnl-2013-303944. Epub 2013 Apr 27.
We analysed long-term results of percutaneous mitral commissurotomy (PMC) performed because of mitral restenosis after previous commissurotomy.
Follow-up of a prospective cohort.
Tertiary university hospital.
We studied 163 consecutive patients who underwent PMC because of restenosis occurring 16 ± 8 years after previous commissurotomy (closed-heart in 121, open-heart in 30 and PMC in 12). Mean age was 48 ± 14 years; 62 patients (38%) had valve calcification. Restenosis was due to bicommissural fusion in all cases.
PMC using a single or double balloon in 80 patients and the Inoue balloon in 83.
Good immediate results (IR) (valve area ≥ 1.5 cm2 with MR ≤ 2/4) were obtained in 135 pts (83%). 20-year rates were 27.9 ± 4.7% for cardiovascular survival without mitral surgery and 14.8 ± 3.9% for good functional results (cardiovascular survival without reintervention on the mitral valve and in New York Heart Association (NYHA) class I or II). After good IR, 20-year rates were 33.2 ± 5.5% for cardiovascular survival without surgery and 17.9 ± 4.7% for good functional results. After good IR, multivariate predictive factors of poor late functional results were higher NYHA class (p = 0.01), atrial fibrillation (p = 0.0002) and higher mean mitral gradient after PMC (p = 0.004).
In patients with restenosis after mitral commissurotomy, PMC provides good IR in most cases. After good IR, one patient out of three remains free from surgery and one out of five has good functional results at 20 years. These findings support the use of PMC after previous commissurotomy, particularly in selected patients with few symptoms and in sinus rhythm.
我们分析了因先前的二尖瓣交界切开术后再狭窄而行经皮二尖瓣交界切开术（PMC）的长期结果。
前瞻性队列研究的随访。
三级大学医院。
我们研究了 163 例连续患者，这些患者因先前的交界切开术后 16±8 年发生再狭窄而行 PMC（121 例为闭式心脏，30 例为开胸心脏，12 例为 PMC）。平均年龄为 48±14 岁；62 例（38%）有瓣膜钙化。所有病例的再狭窄均为双交界融合。
80 例患者采用单球囊或双球囊，83 例患者采用 Inoue 球囊进行 PMC。
135 例（83%）患者即刻效果良好（IR）（瓣口面积≥1.5cm2，MR≤2/4）。20 年心血管生存率无二尖瓣手术为 27.9±4.7%，心功能良好（无二尖瓣再介入且纽约心脏病协会（NYHA）心功能分级 I 或 II 级）为 14.8±3.9%。IR 良好后，20 年心血管生存率无手术为 33.2±5.5%，心功能良好为 17.9±4.7%。IR 良好后，NYHA 分级较高（p=0.01）、心房颤动（p=0.0002）和 PMC 后平均二尖瓣梯度较高（p=0.004）是晚期心功能不良的多变量预测因素。
在因二尖瓣交界切开术后再狭窄的患者中，PMC 在大多数情况下提供良好的 IR。IR 良好后，三分之一的患者无需手术，五分之一的患者 20 年心功能良好。这些发现支持在先前的交界切开术后使用 PMC，特别是在症状较少且窦性心律的患者中。
