Hassanin Ahmed, Alom Modar, Potluri Srinivasa, Al-Azizi Karim
Department of Cardiology, Baylor Scott & White - The Heart Hospital Plano, Plano, Texas, USA.
Struct Heart. 2024 Jun 25;8(5):100330. doi: 10.1016/j.shj.2024.100330. eCollection 2024 Sep.
Percutaneous mitral balloon commissurotomy (PMBC) is the gold standard for the treatment of patients with symptomatic rheumatic mitral valve (MV) stenosis and favorable valve morphology. Intracardiac ultrasound (ICE)-guided PMBC is an attractive alternative to standard transesophageal echocardiography guidance for simplification of procedure and avoiding general anesthesia.
We conducted a retrospective analysis of all ICE-guided PMBC cases at our institution between July 2020 and November 2023. Procedural success was defined as post-PMBC MV area ≥1.5 cm; or an increase of ≥0.5 cm in MV area associated with echocardiographic mitral regurgitation (MR) that is ≤moderate post-PMBC. Six-month follow-up data were collected.
We identified 11 subjects for whom ICE-guided PMBC was attempted. The mean age of the subjects was 61.7 (±12.1) years. All, but one, were females. Out of the 11 subjects, 2 did not undergo PMBC; one had baseline severe MV regurgitation identified on ICE, and the other developed a pericardial effusion following transeptal puncture that needed an urgent pericardial window. The protocol-defined procedural success was achieved in all nine patients who underwent PMBC. Post-PMBC mean MV gradient was 4.4 (±2.0) as compared to 11.1 (±2.9) mmHg at baseline. At 6-month follow-up, 8 of the 9 patients had ≤New York Heart Association class II symptoms.
ICE-guided PMBC appears to be feasible and safe. ICE-guided PMBC offers several advantages over transesophageal echocardiography guidance including improving patient comfort and eliminating the need for patient intubation and general anesthesia.
经皮二尖瓣球囊成形术（PMBC）是治疗有症状的风湿性二尖瓣（MV）狭窄且瓣膜形态良好患者的金标准。心腔内超声（ICE）引导下的PMBC是标准经食管超声心动图引导的一种有吸引力的替代方法，可简化手术过程并避免全身麻醉。
我们对2020年7月至2023年11月在本机构进行的所有ICE引导下的PMBC病例进行了回顾性分析。手术成功定义为PMBC术后MV面积≥1.5 cm²；或MV面积增加≥0.5 cm²，且PMBC术后经超声心动图检查二尖瓣反流（MR）≤中度。收集了6个月的随访数据。
我们确定了11名尝试进行ICE引导下PMBC的受试者。受试者的平均年龄为61.7（±12.1）岁。除1名男性外，其余均为女性。在这11名受试者中，2人未接受PMBC；1人在ICE检查时发现基线存在严重MV反流，另1人在经房间隔穿刺后出现心包积液，需要紧急进行心包开窗引流。所有9名接受PMBC的患者均达到了方案定义的手术成功。PMBC术后平均MV压差为4.4（±2.0）mmHg，而基线时为11.1（±2.9）mmHg。在6个月的随访中，9名患者中有8名纽约心脏协会心功能分级≤Ⅱ级。
ICE引导下的PMBC似乎是可行且安全的。与经食管超声心动图引导相比，ICE引导下的PMBC具有多个优点，包括提高患者舒适度以及无需患者插管和全身麻醉。
