Tastan Ahmet, Ozturk Ali, Senarslan Omer, Ozel Erdem, Uyar Samet, Ozcan Emin Evren, Kozan Omer
Department of Cardiology, Sifa University Faculty of Medicine, Izmir, Turkey.
Department of Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey.
Cardiovasc J Afr. 2016;27(3):147-151. doi: 10.5830/CVJA-2015-062. Epub 2016 Jan 26.
Percutaneous balloon mitral valvuloplasty (BMV) is an important option for the treatment of mitral valve stenosis. The crux of this process is choosing the appropriate Inoue balloon size. There are two methods to do this. One is an empirical formula based on the patient's height, and other is to choose according to the maximal inter-commissural distance of the mitral valve provided by echocardiography.
The study, performed between January 2006 and December 2011, included 128 patients who had moderate to severe mitral stenosis and whose valve morphology was suitable for BMV. Patients were randomised into two groups. One group was allocated to conventional height-based balloon reference sizing (the HBRS group) and the other was allocated to balloons sized by the echocardiographic measurement of the diastolic inter-commissural diameter (the EBRS group).
BMV was assessed as successful in 60 (92.3%) patients in the HBRS group and in 61 (96.8%) in the EBRS group (p = 0.03). The mean of the calculated balloon reference sizes was significantly higher in the HBRS than in the EBRS group [26.3 ± 1.2 mm, 95% confidence interval (CI): 26.1-26.6 vs 25.2 ± 1.1, 95% CI: 25.0-25.4, respectively; p = 0.007]. Final mitral valve areas (MVA) were larger and mitral regurgitation (MR) gt; 2+ was less in the EBRS group (p = 0.02 and p = 0.05, respectively) CONCLUSIONS: EBRS is a method that is independent of body structure. Choosing Inoue balloon size by measuring maximal diastolic annulus diameter by echocardiography for BMV may be an acceptable method for appropriate final MVA and to avoid risk of significant MR.
经皮球囊二尖瓣成形术（BMV）是治疗二尖瓣狭窄的重要选择。该过程的关键是选择合适的Inoue球囊尺寸。有两种方法可以做到这一点。一种是基于患者身高的经验公式，另一种是根据超声心动图提供的二尖瓣最大瓣间距离来选择。
该研究于2006年1月至2011年12月进行，纳入了128例中重度二尖瓣狭窄且瓣膜形态适合BMV的患者。患者被随机分为两组。一组被分配到传统的基于身高的球囊参考尺寸确定方法（HBRS组），另一组被分配到通过超声心动图测量舒张期瓣间直径来确定球囊尺寸的方法（EBRS组）。
HBRS组60例（92.3%）患者的BMV被评估为成功，EBRS组61例（96.8%）患者的BMV被评估为成功（p = 0.03）。HBRS组计算出的球囊参考尺寸平均值显著高于EBRS组[分别为26.3±1.2mm，95%置信区间（CI）：26.1 - 26.6 vs 25.2±1.1，95%CI：25.0 - 25.4；p = 0.007]。EBRS组的最终二尖瓣面积（MVA）更大，二尖瓣反流（MR）>2+的情况更少（分别为p = 0.02和p = 0.05）。结论：EBRS是一种独立于身体结构的方法。通过超声心动图测量舒张期瓣环最大直径来选择Inoue球囊尺寸用于BMV，可能是获得合适最终MVA并避免严重MR风险的可接受方法。
