Herrmann H C, Wilkins G T, Abascal V M, Weyman A E, Block P C, Palacios I F
Cardiac Unit, Massachusetts General Hospital, Boston 02114.
J Thorac Cardiovasc Surg. 1988 Jul;96(1):33-8.
Percutaneous balloon mitral valvotomy has recently been developed as an alternative to surgical commissurotomy for patients with rheumatic mitral stenosis. We analyzed our initial experience with 60 consecutive procedures performed in 49 patients over 1 1/2 years and identified factors influencing the immediate hemodynamic results. For the total patient population, the mitral valve area increased after percutaneous mitral valvotomy from 0.8 +/- 0.04 to 1.6 +/- 0.11 cm2 (p less than 0.001). Mean diastolic mitral gradient fell from 18 +/- 1 to 7 +/- 0.4 mm Hg (p less than 0.001), and cardiac output increased from 3.8 +/- 0.2 to 4.5 +/- 0.2 L/min (p less than 0.01). Although percutaneous mitral valvotomy resulted in an increase in mitral valve area in each patient, a suboptimal result, as defined by a postprocedure mitral valve area of 1.0 cm2 or less, an increase in area of 25% or less, or a final mitral gradient of 10 mm Hg or more occurred in 21 of the 60 procedures (35%). Multivariate analysis of 16 variables was performed to determine which factors might predict this result. Patients with a suboptimal result were more likely to have severe valve leaflet thickening or immobility and an extreme degree of subvalvular thickening and calcification on echocardiogram. Other factors that predicted a suboptimal result were a smaller effective balloon dilating area and the presence of atrial fibrillation. Thus optimal immediate hemodynamic results can be obtained in the majority of patients undergoing percutaneous mitral valvotomy. Optimal results may be expected in patients in normal sinus rhythm, with pliable mitral leaflets, and with no severe subvalvular disease identified by echocardiography, who undergo dilation with large effective balloon dilating areas.
经皮气囊二尖瓣切开术最近已被开发出来，作为风湿性二尖瓣狭窄患者外科瓣膜交界切开术的替代方法。我们分析了在1年半的时间里对49例患者连续进行的60例手术的初步经验，并确定了影响即时血流动力学结果的因素。对于所有患者，经皮二尖瓣切开术后二尖瓣瓣口面积从0.8±0.04增加到1.6±0.11cm²（p＜0.001）。二尖瓣平均舒张期压力阶差从18±1降至7±0.4mmHg（p＜0.001），心输出量从3.8±0.2增加到4.5±0.2L/分钟（p＜0.01）。虽然经皮二尖瓣切开术使每位患者的二尖瓣瓣口面积都有所增加，但60例手术中有21例（35%）出现了不理想的结果，即术后二尖瓣瓣口面积为1.0cm²或更小、面积增加25%或更少、或最终二尖瓣压力阶差为10mmHg或更高。对16个变量进行了多因素分析，以确定哪些因素可能预测这一结果。结果不理想的患者在超声心动图上更可能有严重的瓣膜增厚或活动受限以及极重度的瓣下增厚和钙化。其他预测结果不理想的因素是有效的球囊扩张面积较小和存在心房颤动。因此，大多数接受经皮二尖瓣切开术的患者可以获得最佳的即时血流动力学结果。对于窦性心律正常、二尖瓣叶柔软且超声心动图未发现严重瓣下疾病、使用大的有效球囊扩张面积进行扩张的患者，可能会有最佳结果。
