Davidson C J, Skelton T N, Kisslo K B, Kong Y, Peter R H, Simonton C A, Phillips H R, Behar V S, Bashore T M
Department of Medicine, Duke University Medical Center, Durham, North Carolina.
Ann Intern Med. 1988 Apr;108(4):557-60. doi: 10.7326/0003-4819-108-4-557.
To prospectively investigate the evidence for embolic phenomena associated with percutaneous mitral and aortic valvuloplasty.
Prospective, consecutive case series before and after balloon valvuloplasty.
Referral center hospital and cardiac catheterization laboratory.
Consecutive sample of 32 patients having balloon valvuloplasty for critical symptomatic stenosis of the mitral or aortic valve. Twenty-six patients had aortic stenosis; 6 had mitral stenosis.
Computed tomography of the head, funduscopy, and electrocardiography were done in all patients before and after valvuloplasty. Cardiac isoenzymes were measured serially in 19 patients.
Previous cerebral infarction was seen in nine patients, with three showing a new abnormality after aortic valvuloplasty. In one of these patients a funduscopic hemorrhage was detected by photography. Total creatinine kinase and MB fraction were elevated in 1 of 19 patients. Serial electrocardiograms were unchanged in all patients.
The incidence of cerebral neurologic events and myocardial injury are acceptably low after balloon valvuloplasty of calcific aortic and mitral stenosis. Both episodes of symptomatic cerebral infarction occurred in patients with apparent bicuspid aortic valvular stenosis, suggesting that calcific bicuspid aortic stenosis may be associated with more neurologic events after aortic valvuloplasty.
前瞻性调查经皮二尖瓣和主动脉瓣成形术相关栓塞现象的证据。
球囊瓣膜成形术前后的前瞻性连续病例系列研究。
转诊中心医院和心脏导管实验室。
连续抽取32例因严重症状性二尖瓣或主动脉瓣狭窄接受球囊瓣膜成形术的患者。26例为主动脉瓣狭窄；6例为二尖瓣狭窄。
所有患者在瓣膜成形术前后均进行头部计算机断层扫描、眼底镜检查和心电图检查。对19例患者连续测量心肌同工酶。
9例患者既往有脑梗死，3例在主动脉瓣成形术后出现新的异常。其中1例患者经眼底照相发现眼底出血。19例患者中有1例总肌酸激酶和肌酸激酶同工酶MB升高。所有患者的系列心电图均无变化。
钙化性主动脉瓣和二尖瓣狭窄球囊瓣膜成形术后，脑神经系统事件和心肌损伤的发生率较低，在可接受范围内。有症状的脑梗死发作均发生在明显的二叶式主动脉瓣狭窄患者中，提示钙化性二叶式主动脉瓣狭窄在主动脉瓣成形术后可能与更多的神经系统事件相关。
