Chichareon Ply, Nilmoje Thanapon, Suwanugsorn Saranyou, Chamnarnphol Noppadol, Thungthienthong Metus, Geater Sarayuth Lucien, Jintapakorn Woravut
Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Naradhiwas Rajanagarindra Heart Center, Songklanagarind Hospital, Songkhla, Thailand.
Cardiovasc Diagn Ther. 2022 Oct;12(5):552-562. doi: 10.21037/cdt-22-140.
Percutaneous balloon mitral valvuloplasty (PBMV) is contraindicated in mitral stenosis (MS) with moderate mitral regurgitation (MR) according to the European guidelines. However, small-sized studies have demonstrated the feasibility and safety of PBMV in these patients. We aimed to study the procedural success and mid-term outcomes of PBMV in MS patients with moderate MR.
The present study was a retrospective cohort study in consecutive patients with severe rheumatic MS who underwent PBMV with the Inoue technique in Songklanagarind hospital. The severity of mitral regurgitation was assessed with qualitative Doppler. The patients were grouped according to their MR severity before PBMV into moderate MR or less-than-moderate MR. Procedural success and a composite of all-cause death, mitral valve surgery or re-PBMV were compared between the two groups.
Of 618 patients with rheumatic MS who underwent PBMV in Songklanagarind hospital between January 2003 and October 2020, 598 patients (96.8%) had complete information of pre-PBMV MR severity and procedural success. Forty-nine patients (8.2%) had moderate MR before PBMV. Moderate MR before PBMV was not associated with a lower chance of PBMV success (moderate MR less-than-moderate MR before PBMV; adjusted OR 0.65, 95% CI: 0.32-1.29, P=0.22). Survival probability of all-cause death, MV surgery or re-PBMV in the group with moderate MR before PBMV was not different from the group with less-than-moderate MR (adjusted HR 1.30, 95% CI: 0.98-1.62, P=0.10).
PBMV is an effective and safe treatment in rheumatic MS with moderate MR.
根据欧洲指南，经皮二尖瓣球囊成形术（PBMV）在伴有中度二尖瓣反流（MR）的二尖瓣狭窄（MS）患者中为禁忌。然而，小规模研究已证明PBMV在这些患者中的可行性和安全性。我们旨在研究PBMV在伴有中度MR的MS患者中的手术成功率和中期结局。
本研究是一项回顾性队列研究，纳入了宋卡纳卡林医院连续接受Inoue技术PBMV的重度风湿性MS患者。采用定性多普勒评估二尖瓣反流的严重程度。患者根据PBMV前MR的严重程度分为中度MR组或低于中度MR组。比较两组的手术成功率以及全因死亡、二尖瓣手术或再次PBMV的复合结局。
2003年1月至2020年10月期间在宋卡纳卡林医院接受PBMV的618例风湿性MS患者中，598例（96.8%）有PBMV前MR严重程度和手术成功率的完整信息。49例（8.2%）患者在PBMV前有中度MR。PBMV前的中度MR与PBMV成功几率较低无关（PBMV前中度MR组低于中度MR组；调整后的OR为0.65，95%CI：0.32 - 1.29，P = 0.22）。PBMV前中度MR组全因死亡、二尖瓣手术或再次PBMV的生存概率与低于中度MR组无差异（调整后的HR为1.30，95%CI：0.98 - 1.62，P = 0.10）。
PBMV是治疗伴有中度MR的风湿性MS的一种有效且安全的方法。
