青少年风湿性二尖瓣狭窄的球囊二尖瓣成形术：与成人即刻结果的比较
Balloon mitral valvotomy in juvenile rheumatic mitral stenosis: comparison of immediate results with adults.
作者信息
Karur Satish, Veerappa Virupakshappa, Nanjappa Manjunath C
机构信息
Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India - 560069.
Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India - 560069.
出版信息
Heart Lung Circ. 2014 Dec;23(12):1165-8. doi: 10.1016/j.hlc.2014.04.261. Epub 2014 Jun 6.
AIMS
The objective of the study was to study and compare the clinical, echocardiographic and haemodynamic profile of juvenile rheumatic mitral stenosis (age ≤20 years) with severe mitral stenosis in adults, both before and immediately after balloon mitral valvotomy and also to evaluate the safety and efficacy of the procedure in juvenile patients.
METHODS
Forty juvenile patients aged 20 years or younger were analysed with 40 consecutive adult patients who underwent balloon mitral valvotomy using Accura balloon in our institution. The procedure was successful in all the patients. The clinical, echocardiographic and haemodynamic parameters were compared pre- and post-balloon mitral valvotomy in both the groups.
RESULTS
New York Heart Association functional class was comparable in both the groups (II and III, 62.5% and 37.5% vs. 60% and 40%). Atrial fibrillation was not seen in the juvenile group whereas 25% of the adult group had atrial fibrillation (p<0.001). Mitral valve deformity was comparable (Wilkins Score - 8.57±0.67 vs. 8.6±0.67, p=NS). Mitral valve area index by 2D echo was 0.62±0.097 cm2/m2 in the juvenile group and 0.621±0.097 cm2/m2 in the adult group (p=0.72) and was larger in the juvenile group (1.38±0.19 vs 1.29±0.18 cm2/m2) after the procedure (p value <0.03). Mitral valve gradient (19.85±7.31 mm hg vs. 14.63±5.33 mm hg. P value<0.001) and mean PASP (70.15±1+.2 mm hg vs. 60.10±19.32 mm of hg. P value <0.02) was higher in the juvenile group before balloon mitral valvotomy, after balloon mitral valvotomy the values were 7.45±2.57 vs. 5.78±2.24 mm of hg, (P<0.003) and 40.48±10.30 vs. 41±15.62 respectively (p=0.85). The mean value for left atrial pressure was comparable in both the groups both pre- and post-balloon mitral valvotomy (P value 0.076 and 0.54 respectively). There was no significant difference in the procedural success (95% vs 100%, p value <0.15).
CONCLUSION
Balloon mitral valvotomy is safe and effective in young with rheumatic mitral stenosis and provides better immediate results compared to adults.
目的
本研究的目的是研究并比较青少年风湿性二尖瓣狭窄（年龄≤20岁）与成人重度二尖瓣狭窄患者在球囊二尖瓣成形术前及术后即刻的临床、超声心动图和血流动力学特征，并评估该手术在青少年患者中的安全性和有效性。
方法
对40例20岁及以下的青少年患者与40例在我院接受使用Accura球囊进行球囊二尖瓣成形术的成年患者进行分析。所有患者手术均成功。比较两组患者球囊二尖瓣成形术前及术后的临床、超声心动图和血流动力学参数。
结果
两组纽约心脏协会心功能分级相当（II级和III级，分别为62.5%和37.5%对比60%和40%）。青少年组未出现心房颤动，而成人组有25%出现心房颤动（p<0.001）。二尖瓣畸形程度相当（威尔金斯评分 - 8.57±0.67对比8.6±0.67，p=无统计学意义）。二维超声心动图测得的二尖瓣面积指数在青少年组为0.62±0.097 cm2/m2，在成人组为0.621±0.097 cm2/m2（p=0.72），术后青少年组更大（1.38±0.19对比1.29±0.18 cm2/m2）（p值<0.03）。球囊二尖瓣成形术前青少年组二尖瓣压差（19.85±7.31 mmHg对比14.63±5.33 mmHg，p值<0.001）和平均肺动脉收缩压（70.15±14.2 mmHg对比60.10±19.32 mmHg，p值<0.02）更高，球囊二尖瓣成形术后分别为7.45±2.57对比5.78±2.24 mmHg（P<0.003）和40.48±10.30对比41±15.62（p=0.85）。两组球囊二尖瓣成形术前及术后左心房压力平均值相当（p值分别为0.076和0.54）。手术成功率无显著差异（95%对比100%，p值<0.15）。
结论
球囊二尖瓣成形术在患有风湿性二尖瓣狭窄的青少年中安全有效，与成人相比能提供更好的即刻效果。
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