Nishimura Y, Nakata H, Ohnishi H, Takenaka K, Maeda H, Yokoyama M
Department of Respiratory Disease, Takatsuki General Hospital, Osaka, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1994 Sep;32(9):831-5.
To study the effects of percutaneous transluminal mitral commissurotomy (PTMC) on bronchial responsiveness to inhaled methacholine in patients with mitral valve stenosis (MS), methacholine inhalation tests and pulmonary function tests were done in 10 patients with MS before and one week after PTMC. The mean log cumulative dose producing a 35% decrease in respiratory conductance (PD35Grs) was significantly higher after PTMC in nine patients in whom PTMC was successful (p < 0.05). There were no significant changes in the results of pulmonary function tests after PTMC. One patient had severe mitral regurgitation after PTMC, and a decrease in PD35Grs. Six of the other nine patients in whom PTMC was successful continued to be hyperresponsive to inhaled methacholine. These data show that bronchial hyperresponsiveness in patients with MS is less severe after PTMC, concomitant with the relief of pulmonary congestion, and they suggest that the remaining bronchial hyperresponsiveness is responsible for peripheral airway narrowing with organic remodeling.
为研究经皮腔内二尖瓣交界切开术（PTMC）对二尖瓣狭窄（MS）患者支气管对吸入乙酰甲胆碱反应性的影响，对10例MS患者在PTMC术前及术后1周进行了乙酰甲胆碱吸入试验和肺功能测试。在9例PTMC成功的患者中，术后产生呼吸传导率降低35%的平均对数累积剂量（PD35Grs）显著升高（p<0.05）。PTMC术后肺功能测试结果无显著变化。1例患者PTMC术后出现严重二尖瓣反流，且PD35Grs降低。在其他9例PTMC成功的患者中，有6例对吸入乙酰甲胆碱仍呈高反应性。这些数据表明，MS患者PTMC术后支气管高反应性减轻，同时肺淤血缓解，提示残留的支气管高反应性是导致外周气道狭窄伴器质性重塑的原因。
