García-Castillo A, Treviño A J, Ibarra M, Palacios J M, Uribe A, de la Fuente F, Mendirichaga R, Enríquez C, Astorga A, Elizondo L
Departamento de Cardiología y Hemodinámica, Hospital de Especialidades No. 25., I.M.S.S., Monterrey N.L.
Arch Inst Cardiol Mex. 1995 Jan-Feb;65(1):39-47.
From October 1991 to October 1993, a total of 205 patients with rheumatic mitral stenosis (178 female, 27 male, mean age 38 years, range 17-72) underwent percutaneous transvenous mitral commissurotomy (PTMC), 138 with the Inoue balloon and 67 with double balloon-catheter techniques. Mitral regurgitation (MR) was detected in 10% of the cases prior to the procedure, and 37% after PTMC (p < 0.05), grade I in 45 patients (22%), grade II in 24 (12%), grade III in 4 (2%), and grade IV in 3 (1.5%) cases (p = 0.003, 0.002, N.S. and N.S., respectively. In 40% of the total group (83/205) there was no new or worsening MR; in 26.8% of the cases (55/205) new MR appeared (p = 0.004); in 23% (47/205) MR increased one grade (p = 0.002) and in 9.7% (20/205) two or more grades. The comparative incidence of MR was 40.5% (56/138) with the Inoue balloon, and 16.4% (11/67) with the double balloon technique (p = 0.03); the severity of MR was grade I in 27% vs 9% (p = 0.001), grade II in 9.4% vs 6% (p = 0.05), grade III in 2.1% vs 1.5% (N.S.), and grade IV in 2.1% vs 0% (N.S.). Only the presence of commissural calcification and echo-score > 8 points were found as independent predictors of severe MR. In conclusion, mild and moderate MR occur frequently after PTMC, with significantly greater incidence using the Inoue technique. Severe MR following PTMC is much less frequent, and the comparative incidence is somewhat greater with the Inoue balloon, though the difference is not significant.
1991年10月至1993年10月，共有205例风湿性二尖瓣狭窄患者（178例女性，27例男性，平均年龄38岁，年龄范围17 - 72岁）接受了经皮经静脉二尖瓣交界切开术（PTMC），其中138例使用Inoue球囊技术，67例使用双球囊导管技术。术前10%的病例检测到二尖瓣反流（MR），PTMC术后为37%（p < 0.05），45例（22%）为I级，24例（12%）为II级，4例（2%）为III级，3例（1.5%）为IV级（p分别为0.003、0.002、无统计学意义和无统计学意义）。在全部病例的40%（83/205）中，没有新的或加重的MR；26.8%的病例（55/205）出现了新的MR（p = 0.004）；23%（47/205）的病例MR升高一级（p = 0.002），9.7%（20/205）的病例升高两级或更多级。使用Inoue球囊技术时MR的发生率为40.5%（56/138），使用双球囊技术时为16.4%（11/67）（p = 0.03）；MR的严重程度I级分别为27%和9%（p = 0.001），II级分别为9.4%和6%（p = 0.05），III级分别为2.1%和1.5%（无统计学意义），IV级分别为2.1%和0%（无统计学意义）。仅发现瓣叶钙化的存在和超声评分> 8分是严重MR的独立预测因素。总之，PTMC术后轻度和中度MR频繁发生，使用Inoue技术时发生率显著更高。PTMC术后严重MR的发生频率要低得多，使用Inoue球囊时的发生率略高，尽管差异不显著。
