Khan Imran, Shah Bakhtawar, Habeel Dar Mohammad, Khan Adnan, Faisal Iftekhar Malik, Sami Abdul
Cardiology/cardiac Electrophysiology, Hayatabad Medical Complex Peshawar.
Cardiology, Hayatabad Medical Complex Peshawar.
Cureus. 2017 Sep 29;9(9):e1726. doi: 10.7759/cureus.1726.
Background The objective of the study was to determine the long-term outcomes, including mitral restenosis and regurgitation, after successful percutaneous transvenous mitral commissurotomy (PTMC). Methods This cross-sectional prospective study was conducted at the cardiology department of Lady Reading Hospital, Peshawar, Pakistan, from January 2007 to December 2009. A total of 84 patients were followed up for a period of 96 months. Pre and post percutaneous transvenous mitral commissurotomy echocardiography was done on the mitral valve area (MVA) using two-dimensional (2D) and color doppler echocardiography. Patients who had successful PTMC were followed up for MVA loss, mitral regurgitation (MR), and cardiac death. SPSS Software (IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY: IBM Corp.; 2013) was used for data analysis. Results Of the 84 patients, 21 were male, and 63 were females. The mean age was 35 ± 11 years. After PTMC, the mean valve two-dimensional area increased from 0.84 ± 0.13 to 1.83 ± 0.49 cm (p value <0.001). MR was mild in 49 patients (62.8%), moderate in 27 patients (34.6%), and severe in two patients (2.6%). Good results were achieved in 60 (71.4%). Patients with good results were younger (24 ± 4), and had a relatively lower Wilkin's score, with a mean value of (8.4 ± 2.8). Follow-up events were death in six patients, mitral valve replacement (MVR) in 10 patients, and restenosis in seven patients. The Kaplan-Meier curve was used for the follow-up end points. Patient who required PTMC for mitral restenosis survived for a longer time than those requiring MVR, and those who had cardiac death due to severe pulmonary hypertension or heart failure. Conclusion Patients who had favorable Wilkin's score and underwent PTMC for severe symptomatic mitral stenosis had better event-free survival in the long term follow-up.
本研究的目的是确定成功实施经皮经静脉二尖瓣交界切开术（PTMC）后的长期结局，包括二尖瓣再狭窄和反流。方法：这项横断面前瞻性研究于2007年1月至2009年12月在巴基斯坦白沙瓦市雷丁夫人医院心脏病科进行。共对84例患者进行了96个月的随访。在经皮经静脉二尖瓣交界切开术前和术后，使用二维（2D）和彩色多普勒超声心动图对二尖瓣面积（MVA）进行检查。对成功实施PTMC的患者进行随访，观察MVA减小、二尖瓣反流（MR）和心源性死亡情况。使用SPSS软件（IBM SPSS Statistics for Windows，版本22.0，纽约州阿蒙克市：IBM公司；2013年）进行数据分析。结果：84例患者中，男性21例，女性63例。平均年龄为35±11岁。PTMC术后，平均瓣膜二维面积从0.84±0.13平方厘米增加到1.83±0.49平方厘米（p值<0.001）。49例患者（62.8%）的MR为轻度，27例患者（34.6%）为中度，2例患者（2.6%）为重度。60例（71.4%）取得了良好效果。取得良好效果的患者年龄较轻（24±4岁），威尔金评分相对较低，平均值为（8.4±2.8）。随访事件包括6例患者死亡，10例患者进行二尖瓣置换术（MVR），7例患者出现再狭窄。采用Kaplan-Meier曲线作为随访终点。因二尖瓣再狭窄需要进行PTMC的患者比需要进行MVR的患者存活时间更长，也比因严重肺动脉高压或心力衰竭导致心源性死亡的患者存活时间更长。结论：威尔金评分良好且因严重症状性二尖瓣狭窄接受PTMC的患者在长期随访中无事件生存期更好。
