二尖瓣狭窄合并心房颤动患者经皮经静脉二尖瓣交界切开术的即刻临床和超声心动图结果

Immediate Clinical and Echocardiographic Outcome of Percutaneous Transvenous Mitral Commissurotomy for Patients of Mitral Stenosis with Atrial Fibrillation.

作者信息

Rahman M T, Rahman M M, Islam M M, Khan M R, Haque S A, Chowdhury A W, Majumder A S, Rahman A, Islam Q I

机构信息

Dr Md Toufiqur Rahman, Associate Professor, Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh.

出版信息

Mymensingh Med J. 2015 Jul;24(3):585-91.

PMID:26329959

Abstract

Rheumatic fever and rheumatic heart disease continue to be the major health problem in all developing countries including Bangladesh. Rheumatic mitral stenosis is a very common problem in our population having an incidence of 54 percent among rheumatic heart disease with a female preponderance of 2:1. Percutaneous balloon mitral commissurotomy is appealing because the mechanism of valve dilation closely parallels the mechanism of surgical mitral commissurotomy. The technique of balloon mitral commissurotomy has evolved rapidly, with improvements in balloons, guide wires, and the application of double-balloon techniques. There is controversy that whether the presence of AF has a direct negative effect on the immediate or long-term outcome after PTMC in mitral stenosis patients. The purpose of this study was to see the effect of atrial fibrillation (AF) on the immediate clinical and echocardiographic outcome of patients undergoing Percutaneous Transvenous Mitral Commissurotomy (PTMC). The immediate procedural and in-hospital clinical outcome after PTMC of 264 patients with AF were prospectively collected and compared with those of 288 patients in normal sinus rhythm (NSR) with mitral stenosis admitted in National Institute of Cardiovascular Diseases, Dhaka and Al-Helal Heart Institute, Mirpur, Dhaka, Bangladesh. Patients with AF were older than patients with normal sinus rhythm (53 ± 11 vs. 33 ± 12 years; p<0.0001) and presented more frequently with New York Heart Association (NYHA) class III-IV (78.3% vs. 58.5%; p<0.0001), echocardiographic score >8 (38.9% vs. 22.7%; p<0.0001), calcified valves under fluoroscopy (22.2% vs.12.4%, p<0.0001) and with history of previous surgical commissurotomy (21.7% vs. 10.5%; p<0.0001). In patients with AF, PTMC resulted in worse outcomes, as reflected in a smaller post-PTMC mitral valve area (1.6±0.4 vs. 2.1 ± 0.8 cm²; p<0.0001). Patients with atrial fibrillation have a worse immediate clinical and echocardiographic outcome after PTMC.

摘要

风湿热和风湿性心脏病仍然是包括孟加拉国在内的所有发展中国家的主要健康问题。风湿性二尖瓣狭窄在我国人群中是一个非常常见的问题，在风湿性心脏病中发病率为54%，女性患病率为2:1。经皮气球二尖瓣交界切开术很有吸引力，因为瓣膜扩张机制与外科二尖瓣交界切开术的机制非常相似。气球二尖瓣交界切开术技术发展迅速，在球囊、导丝以及双球囊技术的应用方面都有改进。对于二尖瓣狭窄患者，房颤的存在是否对经皮球囊二尖瓣交界切开术（PTMC）后的近期或长期结果有直接负面影响存在争议。本研究的目的是观察心房颤动（AF）对接受经皮经静脉二尖瓣交界切开术（PTMC）患者的近期临床和超声心动图结果的影响。前瞻性收集了264例房颤患者PTMC后的即时手术和住院临床结果，并与孟加拉国达卡国家心血管疾病研究所和达卡米尔布尔的Al-Helal心脏研究所收治的288例二尖瓣狭窄且窦性心律正常（NSR）患者的结果进行比较。房颤患者比窦性心律正常的患者年龄更大（53±11岁 vs. 33±12岁；p<0.0001），纽约心脏协会（NYHA）III-IV级的比例更高（78.3% vs. 58.5%；p<0.0001），超声心动图评分>8的比例更高（38.9% vs. 22.7%；p<0.0001），透视下瓣膜钙化的比例更高（22.2% vs.12.4%，p<0.0001），有既往外科交界切开术史的比例更高（21.7% vs. 10.5%；p<0.0001）。在房颤患者中，PTMC导致的结果更差，如PTMC后二尖瓣瓣口面积更小（1.6±0.4 vs. 2.1±0.8 cm²；p<0.0001）。房颤患者PTMC后的近期临床和超声心动图结果更差。