Wilkins G T, Weyman A E, Abascal V M, Block P C, Palacios I F
Department of Medicine, Massachusetts General Hospital, Boston 02114.
Br Heart J. 1988 Oct;60(4):299-308. doi: 10.1136/hrt.60.4.299.
Twenty two patients (four men, 18 women, mean age 56 years, range 21 to 88 years) with a history of rheumatic mitral stenosis were studied by cross sectional echocardiography before and after balloon dilatation of the mitral valve. The appearance of the mitral valve on the pre-dilatation echocardiogram was scored for leaflet mobility, leaflet thickening, subvalvar thickening, and calcification. Mitral valve area, left atrial volume, transmitral pressure difference, pulmonary artery pressure, cardiac output, cardiac rhythm, New York Heart Association functional class, age, and sex were also studied. Because there was some increase in valve area in almost all patients the results were classified as optimal or suboptimal (final valve area less than 1.0 cm2, final left atrial pressure greater than 10 mm Hg, or final valve area less than 25% greater than the initial area). The best multiple logistic regression fit was found with the total echocardiographic score alone. A high score (advanced leaflet deformity) was associated with a suboptimal outcome while a low score (a mobile valve with limited thickening) was associated with an optimal outcome. No other haemodynamic or clinical variables emerged as predictors of outcome in this analysis. Examination of pre-dilatation and post-dilatation echocardiograms showed that balloon dilatation reliably resulted in cleavage of the commissural plane and thus an increase in valve area.
对22例有风湿性二尖瓣狭窄病史的患者（4例男性，18例女性，平均年龄56岁，范围21至88岁）在二尖瓣球囊扩张术前和术后进行了横断面超声心动图研究。对扩张前超声心动图上二尖瓣的表现进行评分，包括瓣叶活动度、瓣叶增厚、瓣下增厚和钙化情况。还研究了二尖瓣面积、左心房容积、跨二尖瓣压差、肺动脉压、心输出量、心律、纽约心脏协会心功能分级、年龄和性别。由于几乎所有患者的瓣膜面积都有一定增加，结果被分为最佳或次优（最终瓣膜面积小于1.0平方厘米，最终左心房压力大于10毫米汞柱，或最终瓣膜面积比初始面积增加小于25%）。单独使用超声心动图总评分时发现最佳多元逻辑回归拟合。高分（严重瓣叶畸形）与次优结果相关，而低分（活动瓣膜且增厚有限）与最佳结果相关。在该分析中，没有其他血流动力学或临床变量成为结果的预测因素。对扩张前和扩张后超声心动图的检查表明，球囊扩张可靠地导致瓣叶联合平面裂开，从而使瓣膜面积增加。
