Lock J E, Khalilullah M, Shrivastava S, Bahl V, Keane J F
N Engl J Med. 1985 Dec 12;313(24):1515-8. doi: 10.1056/NEJM198512123132405.
We attempted percutaneous transcatheter-balloon mitral commissurotomy in eight children and young adults (9 to 23 years of age) with rheumatic mitral stenosis. The atrial septum was traversed by needle puncture, and an 8-mm angioplasty balloon was advanced over a guide wire. The atrial septal perforation was then dilated to allow passage of the valvuloplasty balloon catheter (18 to 25 mm) across the mitral annulus. Inflation of the transmitral balloon decreased the end-diastolic transmitral gradient temporarily in all patients (from 21.2 +/- 4.0 mm Hg [mean +/- S.D.] to 10.1 +/- 5.5 mm Hg; P less than 0.001). The immediate decrease in the gradient was associated with increases in cardiac output (from 3.8 +/- 1.0 to 4.9 +/- 1.3 liters per minute per square meter of body-surface area; P less than 0.01) and in the calculated mitral-valve-area index (from 0.73 +/- 0.29 to 1.34 +/- 0.32 cm2 per square meter; P less than 0.001). Murmur intensity diminished immediately after commissurotomy in all patients. The greatest reduction in pressure gradient (76 to 95 per cent) occurred when the largest balloon (inflated diameter, 25 mm) was used in the smallest patients (0.9 to 1.2 m2). The balloon commissurotomy produced minimal mitral regurgitation in only one child. Follow-up catheterization (at two to eight weeks) demonstrated persistence of hemodynamic improvement with evidence of partial restenosis in one patient. These early results indicate that balloon mitral commissurotomy can be a safe and effective treatment for children and young adults with rheumatic mitral stenosis.
我们对8名患有风湿性二尖瓣狭窄的儿童和青年（9至23岁）尝试了经皮经导管球囊二尖瓣交界切开术。通过针刺穿过房间隔，将一根8毫米的血管成形术球囊沿导丝推进。然后扩张房间隔穿孔，以使瓣膜成形术球囊导管（18至25毫米）穿过二尖瓣环。二尖瓣球囊充盈使所有患者的舒张末期二尖瓣压差暂时降低（从21.2±4.0毫米汞柱[平均值±标准差]降至10.1±5.5毫米汞柱；P<0.001）。压差的即刻降低与心输出量增加（从每平方米体表面积每分钟3.8±1.0升增至4.9±1.3升；P<0.01）以及计算得出的二尖瓣面积指数增加（从每平方米0.73±0.29平方厘米增至1.34±0.32平方厘米；P<0.001）相关。所有患者在交界切开术后杂音强度立即减弱。当在最小的患者（体表面积0.9至1.2平方米）中使用最大的球囊（充盈直径25毫米）时，压差降低幅度最大（76%至95%）。球囊交界切开术仅在1名儿童中产生了轻微的二尖瓣反流。随访心导管检查（在2至8周时）显示血流动力学改善持续存在，1例患者有部分再狭窄的证据。这些早期结果表明，球囊二尖瓣交界切开术对于患有风湿性二尖瓣狭窄的儿童和青年可能是一种安全有效的治疗方法。
