Sugiyama A, Oda H, Matsubara T, Kano M, Nishida Y, Matsuno Y, Kotoo Y, Ohashi H, Watanabe S, Ishiguro M
Department of Cardiology, Prefectural Gifu Hospital.
J Cardiol. 1994 Sep-Oct;24(5):397-403.
Fifty-eight consecutive patients underwent percutaneous transvenous mitral commissurotomy (PTMC) for mitral stenosis from August 1987 to June 1990. Patients were divided by echocardiographic characteristics of the mitral valve according to the Sellors classification into three groups: group 1 (mobile cusps, 20 patients), group 2 (thickened cusps, 34 patients), group 3 (rigid cusps, 4 patients). Immediately after PTMC, the mitral valve area increased significantly from 1.41 +/- 0.37 to 2.07 +/- 0.38 cm2 (p < 0.01) in group 1 and from 1.09 +/- 0.21 to 1.64 +/- 0.25 cm2 (p < 0.01) in group 2. The mitral valve area did not increase significantly in group 3 (from 0.82 +/- 0.27 to 1.10 +/- 0.22 cm2). Mitral regurgitation developed or increased in severity in four patients (100%) in group 3 (p < 0.01 vs group 1, 20% and group 2, 21%). The symptomatic improvement was 0% for group 3 (p < 0.01 vs group 1, 90% and group 2, 91%). At follow-up period (mean 24.6 months), symptomatic improvement was maintained in 44 patients (76%) of the total patient population. The mitral valve area was maintained well in group 1 and group 2, but three patients in group 2 showed recurrence of symptoms due to valvular restenosis. PTMC is an effective nonsurgical treatment for patients with mobile or with thickened cusps. Surgical method is preferable for patients with rigid cusps.
1987年8月至1990年6月，58例连续性二尖瓣狭窄患者接受了经皮经静脉二尖瓣交界切开术（PTMC）。根据Sellors分类法，根据二尖瓣的超声心动图特征将患者分为三组：1组（活动瓣叶，20例患者），2组（瓣叶增厚，34例患者），3组（僵硬瓣叶，4例患者）。PTMC术后即刻，1组二尖瓣瓣口面积从1.41±0.37显著增加至2.07±0.38 cm²（p<0.01），2组从1.09±0.21增加至1.64±0.25 cm²（p<0.01）。3组二尖瓣瓣口面积未显著增加（从0.82±0.27增加至1.10±0.22 cm²）。3组中有4例患者（100%）出现二尖瓣反流或反流程度加重（与1组20%和2组21%相比，p<0.01）。3组症状改善率为0%（与1组90%和2组91%相比，p<0.01）。在随访期（平均24.6个月），44例（76%）患者症状持续改善。1组和2组二尖瓣瓣口面积维持良好，但2组中有3例患者因瓣膜再狭窄出现症状复发。PTMC是活动瓣叶或瓣叶增厚患者有效的非手术治疗方法。对于僵硬瓣叶患者，手术方法更佳。
