Chioin R, Ramondo A, De Conti F, Isabella G, Cardaioli P, Marchiori M, Lo Presti A, Campisi F, Razzolini R
Cattedra di Cardiologia, Università degli Studi, Padova.
G Ital Cardiol. 1995 Apr;25(4):409-20.
Between December 1988 and December 1992, 235 patients (pts) underwent percutaneous balloon mitral valvuloplasty (PBMV).
There were 55 men (23%) aged 49 +/- 13 years and 180 women (77%) aged 51 +/- 13 years. Previous surgical commissurotomy (PSC) had been performed in 22 pts. Procedure was successful (area > 1.5 cm2 or area increase > or = 50% without mitral regurgitation > 2+) in 91.9% of pts, with increase in mitral valve area from 1.05 +/- 0.2 to 2.26 +/- 0.6 cm2, decrease of transvalvular mean pressure gradient from 14.4 +/- 5.5 to 6.05 +/- 4.91 mm Hg and increase of cardiac index from 2.79 +/- 0.75 to 3.17 +/- 0.9 l/m'/m2 (p < 0.001). Insufficient increase in valve area occurred in 3.8% of pts. Major complications included 5 pts with 3+ mitral regulation (MR) requiring mitral valve replacement (MVR), 2 TIA's (0.85%) and 1 pericardiocentesis (0.42%). At follow-up (mean 18.9 months) clinical improvement was achieved in 93.8% of pts (NYHA class from 2.4 to 1.3); mitral valve area was 1.9 +/- 0.4 cm2 and mean mitral valve gradient 5.3 +/- 2.3 mm Hg. Restenosis (area < 1.5 cm2 or > or = 50% loss of initial gain) occurred in 24 pts (10.16%). Six pts required MVR; 1 pt underwent a second successful PBMV. Multivariate study (logistic regression) identified as independent factors of severe MR NYHA class and PSC; echo score, age and basal mean mitral valve gradient were independent factors for restenosis.
In conclusion, PBMV is a safe technique and stable clinical improvement can be obtained in the majority of pts.
1988年12月至1992年12月期间，235例患者接受了经皮球囊二尖瓣成形术（PBMV）。
男性55例（23%），年龄49±13岁；女性180例（77%），年龄51±13岁。22例患者曾接受过外科二尖瓣交界切开术（PSC）。手术成功率为91.9%（瓣口面积>1.5 cm²或瓣口面积增加≥50%且二尖瓣反流无>2+），二尖瓣瓣口面积从1.05±0.2增加至2.26±0.6 cm²，跨瓣平均压差从14.4±5.5降至6.05±4.91 mmHg，心脏指数从2.79±0.75增加至3.17±0.9 l/min/m²（p<0.001）。3.8%的患者瓣口面积增加不足。主要并发症包括5例出现3+二尖瓣反流（MR）需行二尖瓣置换术（MVR），2例短暂性脑缺血发作（TIA，0.85%），1例心包穿刺（0.42%）。随访（平均18.9个月）时，93.8%的患者临床症状改善（纽约心脏协会心功能分级从2.4级降至1.3级）；二尖瓣瓣口面积为1.9±0.4 cm²，二尖瓣平均压差为5.3±2.3 mmHg。24例患者（10.16%）发生再狭窄（瓣口面积<1.5 cm²或初始增加量丧失≥50%）。6例患者需行MVR；1例患者再次成功接受PBMV。多因素研究（逻辑回归）确定纽约心脏协会心功能分级和PSC是严重MR的独立因素；超声心动图评分、年龄和基础二尖瓣平均压差是再狭窄的独立因素。
总之，PBMV是一种安全的技术，大多数患者可获得稳定的临床改善。
