Kaplan J D, Isner J M, Karas R H, Halaburka K R, Konstam M A, Hougen T J, Cleveland R J, Salem D N
Am J Cardiol. 1987 Feb 1;59(4):318-23. doi: 10.1016/0002-9149(87)90806-x.
Preliminary reports indicate that percutaneous balloon valvuloplasty is efficacious for treatment of mitral stenosis. The present study was designed to evaluate whether anatomic features of stenotic mitral valves in older adults affect the efficacy of balloon valvuloplasty and to determine the mechanism by which increased orifice area is accomplished. Fifteen mitral valves excised intact at the time of mitral valve replacement from patients with no more than 2+/4+ mitral a regurgitation were selected for study. Balloon valvuloplasty was performed using a sequence of dilation catheters with balloons 18 to 25 mm in inflated diameter. Mitral valve area, measured with a conical valve sizer, increased from 0.71 +/- 0.06 cm2 (mean +/- standard error of the mean) to 1.77 +/- 0.19 cm2 (p less than 0.0001) after valvuloplasty, resulting in an increase in calculated orifice area of 185 +/- 27% (range 34 to 407%). The increase in calculated orifice area correlated inversely with orifice area before valvuloplasty (r = -0.57; p = 0.026), but was unrelated to extent of calcific deposits on the prevalvuloplasty x-ray of the excised mitral valve. Gross examination together with x-ray analysis after valvuloplasty revealed that the mechanism of balloon valvuloplasty in each case involved commissural splitting, including splits through heavily calcified commissures, without grossly apparent detachment of tissue fragments. These findings suggest that balloon valvuloplasty augments the functional mitral valve orifice area in a manner analogous to standard surgical commissurotomy, and balloon valvuloplasty is likely to be efficacious for a wide spectrum of adult mitral valvular stenosis, including severe stenosis with extensive calcific deposits.
初步报告表明，经皮气囊瓣膜成形术治疗二尖瓣狭窄有效。本研究旨在评估老年患者狭窄二尖瓣的解剖特征是否会影响气囊瓣膜成形术的疗效，并确定实现瓣口面积增加的机制。从二尖瓣反流不超过2+/4+的患者中，选择15个在二尖瓣置换时完整切除的二尖瓣进行研究。使用一系列扩张导管进行气囊瓣膜成形术，气囊充气直径为18至25毫米。用锥形瓣膜测量器测量，瓣膜成形术后二尖瓣面积从0.71±0.06平方厘米（平均值±平均标准误差）增加到1.77±0.19平方厘米（p<0.0001），计算得出的瓣口面积增加了185±27%（范围为34%至407%）。计算得出的瓣口面积增加与瓣膜成形术前的瓣口面积呈负相关（r = -0.57；p = 0.026），但与切除的二尖瓣瓣膜成形术前X线片上钙化沉积的程度无关。瓣膜成形术后的大体检查和X线分析显示，每例气囊瓣膜成形术的机制均涉及交界分离，包括通过严重钙化的交界分离，且无明显的组织碎片脱落。这些发现表明，气囊瓣膜成形术增加二尖瓣功能瓣口面积的方式类似于标准外科交界切开术，并且气囊瓣膜成形术可能对广泛的成人二尖瓣狭窄有效，包括伴有广泛钙化沉积的严重狭窄。
