Turi Zoltan G
Department of Cardiology, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, New Jersey, USA.
Struct Heart. 2022 Sep 21;6(5):100087. doi: 10.1016/j.shj.2022.100087. eCollection 2022 Oct.
Percutaneous balloon mitral valvuloplasty (PBMV), once the most complex of percutaneous cardiac procedures and essentially the first adult structural heart intervention, set the stage for a host of new technologies. Randomized studies comparing PBMV to surgery were the first to provide a high-level evidence base in structural heart. The devices used have changed little in 40 years, but the advent of improved imaging and the expertise gained in interventional cardiology has provided some additional procedural safety. However, with the decline in rheumatic heart disease, PBMV is being performed in fewer patients in industrialized nations; in turn, these patients have more comorbidities, less favorable anatomy, and thus a higher rate of procedure-related complications. There remain relatively few experienced operators, and the procedure is distinct enough from the rest of the structural heart intervention world that it has its own steep learning curve. This article reviews the use of PBMV in a variety of clinical settings, the influence of anatomic and physiologic factors on outcomes, the changes in the guidelines, and alternative approaches. PBMV remains the procedure of choice in patients with mitral stenosis with ideal anatomy and a useful tool in patients with less than ideal anatomy who are poor surgical candidates. In the 40 years since its first performance, PBMV has revolutionized the care of mitral stenosis patients in developing countries and remains an important option for suitable patients in industrialized nations.
经皮球囊二尖瓣成形术（PBMV）曾是最复杂的经皮心脏手术，也是首例成人结构性心脏介入手术，为一系列新技术奠定了基础。比较PBMV与手术治疗的随机研究首次为结构性心脏病提供了高水平的证据基础。40年来，所使用的器械变化不大，但成像技术的改进以及介入心脏病学积累的专业知识提高了手术的安全性。然而，随着风湿性心脏病发病率的下降，工业化国家接受PBMV手术的患者越来越少；相应地，这些患者合并症更多，解剖结构更不理想，因此手术相关并发症的发生率更高。经验丰富的手术医生相对较少，而且该手术与其他结构性心脏介入手术差异较大，有着陡峭的学习曲线。本文回顾了PBMV在各种临床情况下的应用、解剖和生理因素对手术结果的影响、指南的变化以及替代方法。PBMV仍然是解剖结构理想的二尖瓣狭窄患者的首选手术，对于解剖结构不理想且手术风险高的患者也是一种有用的治疗手段。自首次实施以来的40年里，PBMV彻底改变了发展中国家二尖瓣狭窄患者的治疗方式，并且仍然是工业化国家合适患者的重要选择。
