Belcher J R
Ann R Coll Surg Engl. 1979 Jul;61(4):258-64.
It is suggested that restenosis is inevitable after mitral valvotomy and that only the time taken for it to occur is variable. The major factor affecting the lapse of time between operations is the extent of the original valvotomy. Calification of the valve is less important, and coincident mitral incompetence and the age of the patient have almost no influence on the time taken for restenosis to develop. A study has been made of 281 second closed valvotomies and 53 third ones. The operative mortality for second closed valvotomy was 6.7% and for third closed valvotomy 4%. Late emboli were rare. The average follow-up period after second valvotomies was 12.8 years: the condition of 29% of these patients was still satisfactory; 21% had had third valvotomies. At 5 years the condition of 53% was satisfactory. The average length of follow-up after third valvotomy was 6.4 years: the condition of 47% of patients was still satisfactory and the results were similar to those after second valvotomy. It is concluded that closed valvotomy remains the operation of choice when restenosis has occurred.
有人认为二尖瓣切开术后再狭窄是不可避免的，只是其发生时间存在差异。影响再次手术间隔时间的主要因素是初次瓣膜切开术的范围。瓣膜钙化的影响较小，合并二尖瓣关闭不全以及患者年龄对再狭窄发生时间几乎没有影响。对281例二次闭式瓣膜切开术和53例三次闭式瓣膜切开术进行了研究。二次闭式瓣膜切开术的手术死亡率为6.7%，三次闭式瓣膜切开术为4%。晚期栓塞很少见。二次瓣膜切开术后的平均随访期为12.8年：这些患者中29%的情况仍令人满意；21%接受了三次瓣膜切开术。5年时53%的情况令人满意。三次瓣膜切开术后的平均随访期为6.4年：47%的患者情况仍令人满意，结果与二次瓣膜切开术后相似。得出的结论是，当发生再狭窄时，闭式瓣膜切开术仍是首选的手术方式。
