Feldman T, Herrmann H C, Inoue K
Hans Hecht Hemodynamics Laboratory, Pritzker School of Medicine, University of Chicago Hospitals, Illinois.
Cathet Cardiovasc Diagn. 1994;Suppl 2:26-34.
Percutaneous transvenous mitral commissurotomy (PTMC) with the Inoue balloon has had increasing use internationally since its introduction in 1984. This device was designed specifically for mitral commissurotomy and differs substantially from conventional large diameter peripheral arterial or valvuloplasty balloon catheters. It is constructed of two layers of latex with a nylon mesh in between. The latex is extremely compliant, whereas the nylon mesh limits the maximum inflated diameter of the balloon and also gives it a unique shape and set of inflation characteristics. The balloon inflates in three stages. The front half inflates first, creating the appearance of a balloon flotation catheter. The proximal half of the balloon inflates next, creating an hourglass shape. When straddling across the valve, this allows self-positioning of the balloon. Finally, the center portion inflates, resulting in commissurotomy. The technique of commissurotomy involves introducing the balloon into the left atrium over a guidewire and then passing it into the left ventricle with the distal portion of the balloon inflated in a manner analogous to crossing the tricuspid valve with a pulmonary artery flotation catheter. Thus a guidewire is not used to enter the left ventricle with this technique. Increasing inflation volumes allow a single balloon catheter to be inflated to a variety of sizes, allowing stepwise dilatation of the mitral valve in a manner analogous to coronary angioplasty. This report describes the performance of this technique in detail, with practical approaches to many common problems encountered during PTMC.
自1984年引入以来，使用井上球囊进行的经皮经静脉二尖瓣交界切开术（PTMC）在国际上的应用越来越广泛。该装置是专门为二尖瓣交界切开术设计的，与传统的大口径外周动脉或瓣膜成形球囊导管有很大不同。它由两层乳胶中间夹一层尼龙网构成。乳胶具有极高的顺应性，而尼龙网限制了球囊的最大膨胀直径，并赋予其独特的形状和一组膨胀特性。球囊分三个阶段膨胀。前半部分先膨胀，呈现出球囊漂浮导管的样子。接着球囊近端一半膨胀，形成沙漏形状。当横跨瓣膜时，这允许球囊自我定位。最后，中心部分膨胀，实现交界切开。交界切开技术包括通过导丝将球囊引入左心房，然后在球囊远端部分充气的情况下将其送入左心室，这一方式类似于用肺动脉漂浮导管穿过三尖瓣。因此，该技术不用导丝进入左心室。增加充气量可使单个球囊导管膨胀到各种尺寸，从而以类似于冠状动脉血管成形术的方式逐步扩张二尖瓣。本报告详细描述了该技术的操作过程，以及处理PTMC过程中遇到的许多常见问题的实用方法。
