Masaki Ryota, Iwasaki Masamichi, Tanaka Hidekazu, Hamana Tomoyo, Odajima Susumu, Fujimoto Wataru, Kuroda Koji, Hatani Yutaka, Inoue Takumi, Okamoto Hiroshi, Okuda Masanori, Hayashi Takatoshi, Hirata Ken-Ichi
Department of Cardiology, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan.
Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
Cardiovasc Ultrasound. 2020 Apr 13;18(1):10. doi: 10.1186/s12947-020-00193-3.
Balloon aortic valvuloplasty (BAV) offers an alternative to conventional aortic valve replacement in elderly and frail patients with severe aortic stenosis (AS) for whom there are no other effective options. We aimed to investigate the mid-term effect of BAV on mitral regurgitation (MR) in patients with severe AS.
Our analysis was based on the data from 83 patients with severe AS (mean age, 86 ± 5 years; female, 68) treated using BAV. Echocardiography was performed before the procedure and at 1 and 3 months after. MR was quantified by measuring the MR jet area, with more-than-moderate MR being clinically significant.
Forty patients were classified in this group (MR group). Significant reduction of MR was observed in the MR group at 1 month and 3 months after procedure, with no improvement in patients in the non-MR group. At 3 months, 15 of the 40 patients in the MR group still had significant MR, with the change at 1 month in the left ventricular end-systolic dimension (OR: 1.36; 95% CI: 1.05-1.76; P = 0.022) and MR jet area (OR: 1.95; 95% CI: 1.16-3.29; P = 0.012) being predictive of persisting significant MR at 3 months after BAV. The prevalence of New York Heart Association functional class III or IV decreased at 1 and 3 months after BAV in both groups.
BAV provides a useful therapeutic strategy for elderly patients with severe AS who are not candidates for surgical or transcatheter aortic valve replacement, especially in those with significant MR.
对于患有严重主动脉瓣狭窄（AS）且无其他有效选择的老年体弱患者，球囊主动脉瓣成形术（BAV）为传统主动脉瓣置换术提供了一种替代方案。我们旨在研究BAV对严重AS患者二尖瓣反流（MR）的中期影响。
我们的分析基于83例接受BAV治疗的严重AS患者（平均年龄86±5岁；女性68例）的数据。在手术前以及术后1个月和3个月进行超声心动图检查。通过测量MR射流面积对MR进行定量，中度以上MR具有临床意义。
40例患者归入该组（MR组）。MR组在术后1个月和3个月时MR显著降低，非MR组患者无改善。3个月时，MR组40例患者中有15例仍有显著MR，左心室收缩末期内径在1个月时的变化（比值比：1.36；95%可信区间：1.05 - 1.76；P = 0.022）和MR射流面积（比值比：1.95；95%可信区间：1.16 - 3.29；P = 0.012）可预测BAV术后3个月持续存在的显著MR。两组在BAV术后1个月和3个月时纽约心脏协会功能分级III或IV级的患病率均下降。
对于不适合手术或经导管主动脉瓣置换的严重AS老年患者，尤其是那些有显著MR的患者，BAV提供了一种有效的治疗策略。
