风湿性二尖瓣狭窄患者经皮气球二尖瓣成形术后的二尖瓣反流：一项单中心研究。

Mitral regurgitation after percutaneous balloon mitral valvotomy in patients with rheumatic mitral stenosis: a single-center study.

作者信息

Aslanabadi Naser, Toufan Mehrnoush, Salehi Rezvaneyeh, Alizadehasl Azin, Ghaffari Samad, Sohrabi Bahram, Separham Ahmad, Manafi Ataolaah, Mehdizadeh Mohammad Bagher, Habibzadeh Afshin

机构信息

Department of Cardiology, Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

出版信息

J Tehran Heart Cent. 2014;9(3):109-14. Epub 2014 Jul 3.

PMID:25870627

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4393832/

Abstract

BACKGROUND

Percutaneous balloon mitral valvotomy (BMV) is the gold standard treatment for rheumatic mitral stenosis (MS) in that it causes significant changes in mitral valve area (MVA) and improves leaflet mobility. Development of or increase in mitral regurgitation (MR) is common after BMV. This study evaluated MR severity and its changes after BMV in Iranian patients.

METHODS

We prospectively evaluated consecutive patients with severe rheumatic MS undergoing BMV using the Inoue balloon technique between February 2010 and January 2013 in Madani Heart Center, Tabriz, Iran. New York Heart Association (NYHA) functional class and echocardiographic and catheterization data, including MVA, mitral valve mean and peak gradient (MVPG and MVMG), left atrial (LA) pressure, pulmonary artery systolic pressure (PAPs), and MR severity before and after BMV, were evaluated.

RESULTS

Totally, 105 patients (80% female) at a mean age of 45.81 ± 13.37 years were enrolled. NYHA class was significantly improved after BMV: 55.2% of the patients were in NYHA functional class III before BMV compared to 36.2% after the procedure (p value < 0.001). MVA significantly increased (mean area = 0.64 ± 0.29 cm(2) before BMV vs. 1.90 ± 0.22 cm(2) after BMV; p value < 0.001) and PAPs, LA pressure, MVPG, and MVMG significantly decreased. MR severity did not change in 82 (78.1%) patients, but it increased in 18 (17.1%) and decreased in 5 (4.8%) patients. Patients with increased MR had a significantly higher calcification score (2.03 ± 0.53 vs.1.50 ± 0.51; p value < 0.001) and lower MVA before BMV (0.81 ± 0.23 vs.0.94 ± 0.18; p value = 0.010). There were no major complications.

CONCLUSION

In our study, BMV had excellent immediate hemodynamic and clinical results inasmuch as MR severity increased only in some patients and, interestingly, decreased in a few. Our results, underscore BMV efficacy in severe MS. The echocardiographic calcification score was useful for identifying patients likely to have MR development or MR increase after BMV.

摘要

背景

经皮球囊二尖瓣成形术（BMV）是风湿性二尖瓣狭窄（MS）的金标准治疗方法，因为它能显著改变二尖瓣面积（MVA）并改善瓣叶活动度。BMV术后二尖瓣反流（MR）的发生或加重很常见。本研究评估了伊朗患者BMV术后MR的严重程度及其变化。

方法

我们前瞻性评估了2010年2月至2013年1月在伊朗大不里士马丹尼心脏中心使用Inoue球囊技术接受BMV的连续性重度风湿性MS患者。评估纽约心脏协会（NYHA）心功能分级以及超声心动图和心导管检查数据，包括MVA、二尖瓣平均压差和峰值压差（MVPG和MVMG）、左心房（LA）压力、肺动脉收缩压（PAPs）以及BMV术前和术后的MR严重程度。

结果

共纳入105例患者（80%为女性），平均年龄45.81±13.37岁。BMV术后NYHA分级显著改善：BMV术前55.2%的患者为NYHA心功能III级，术后为36.2%（p值<0.001）。MVA显著增加（BMV术前平均面积=0.64±0.29cm²，术后为1.90±0.22cm²；p值<0.001），PAPs、LA压力、MVPG和MVMG显著降低。82例（78.1%）患者的MR严重程度未改变，但18例（17.1%）患者的MR严重程度增加，5例（4.8%）患者的MR严重程度降低。MR加重的患者术前钙化评分显著更高（2.03±0.53对1.50±0.51；p值<0.001），且术前MVA更低（0.81±0.23对0.94±0.18；p值=0.010）。无重大并发症发生。