Zhang Ling, Hou Jiliu, Duan Yulong, Chen Junjun, Du Huijuan, Shi Zhengang
Cardiovaccular Medicine Ward 3, The Second People's Hospital of Pingdingshan, Pingdingshan, China.
Medicine (Baltimore). 2019 Aug;98(32):e16790. doi: 10.1097/MD.0000000000016790.
To study the long-term curative effect of repeat percutaneous balloon mitral valvuloplasty (PBMV) in patients with mitral restenosis.In our study, mitral restenosis developed in 39 patients after PBMV. Repeat PBMV was performed according to the improved Inoue method. All patients were followed up.Of 39 patients, 36 were successfully treated with repeat PBMV (achievement ratio, 92.3%). Immediately after repeat PBMV, clinical symptoms and left atrial mean pressure (LAP), pulmonary artery systolic pressure (PASP), mitral valve gradient (MVG), and mitral valve orifice area (MVA) improved significantly (24.50 ± 6.54 mmHg vs 9.66 ± 4.21 mmHg for LAP, 1.05 ± 0.19 cm vs 2.23 ± 0.22 cm for MVA, 17.03 ± 4.52 mmHg vs 7.79 ± 4.07 mmHg for MVG, 58.12 ± 12.68 mmHg vs 31.45 ± 10.02 mmHg for PASP; P <.05). Meanwhile, left atrial end-diastolic dimension (LAD) was altered slightly (4.71 ± 0.75 vs 4.07 ± 0.69, P >.05). The 36 patients were followed up for 69 ± 23 (12-146) months. After long-term follow-up immediately after repeat PBMV, the results did not show a significant change (2.23 ± -0.22 cm vs 2.02 ± -0.21 cm for MVA, 7.79 ± -4.07 mmHg vs 9.15 ± -4.11 mmHg for MVG; P >.05) and were approximated to those shortly after repeat PBMV (2.23 ± 0.22 cm vs 2.02 ± 0.21 cm for MVA, 7.79 ± 4.07 mmHg vs 9.15 ± 4.11 mmHg for MVG; P > 0.05). LAD did not change significantly (4.13 ± 0.71 cm vs. 4.07 ± 0.69 cm; P >.05). The long-term follow-up results showed that cardiac function and quality of life were significantly improved in most patients.It would be safe for patients with mitral restenosis to undergo repeat PBMV. Appropriate cases should be selected, and treatment should be performed cautiously. Short- and long-term curative effects would be satisfactory. We suggested that repeat PBMV be the first choice for patients with mitral restenosis after first PBMV.
研究经皮球囊二尖瓣成形术（PBMV）重复治疗二尖瓣再狭窄患者的长期疗效。在我们的研究中，39例患者在PBMV术后出现二尖瓣再狭窄。按照改良的Inoue方法进行重复PBMV。对所有患者进行随访。39例患者中，36例成功接受重复PBMV治疗（成功率92.3%）。重复PBMV术后即刻，临床症状以及左房平均压（LAP）、肺动脉收缩压（PASP）、二尖瓣跨瓣压差（MVG）和二尖瓣口面积（MVA）均显著改善（LAP：24.50±6.54 mmHg 对比 9.66±4.21 mmHg；MVA：1.05±0.19 cm 对比 2.23±0.22 cm；MVG：17.03±4.52 mmHg 对比 7.79±4.07 mmHg；PASP：58.12±12.68 mmHg 对比 31.45±10.02 mmHg；P＜0.05）。同时，左房舒张末内径（LAD）略有改变（4.71±0.75对比4.07±0.69，P＞0.05）。36例患者随访69±23（12 - 146）个月。重复PBMV术后长期随访结果显示，各项指标无显著变化（MVA：2.23± - 0.22 cm对比2.02± - 0.21 cm；MVG：7.79± - 4.07 mmHg对比9.15± - 4.11 mmHg；P＞0.05），且与重复PBMV术后短期内结果相近（MVA：2.23±0.22 cm对比2.02±0.21 cm；MVG：7.79±4.07 mmHg对比9.15±4.11 mmHg；P＞0.05）。LAD无显著变化（4.13±0.71 cm对比4.07±0.69 cm；P＞0.05）。长期随访结果显示，大多数患者的心功能和生活质量显著改善。二尖瓣再狭窄患者接受重复PBMV是安全的。应选择合适病例并谨慎进行治疗。短期和长期疗效均令人满意。我们建议，重复PBMV是首次PBMV术后二尖瓣再狭窄患者的首选治疗方法。
