Rihal C S, Holmes D R
McMaster University, Hamilton, Ontario.
Cathet Cardiovasc Diagn. 1994;Suppl 2:35-41.
A variety of techniques have been developed for performing percutaneous balloon mitral valvuloplasty. Two approaches, the Inoue catheter and double-balloon technique, have had the widest application. The Inoue procedure is technically simpler, with shorter fluoroscopy and procedure times. Acute hemodynamic results are excellent for both procedures, which result in significant reductions of left atrial pressure, transmitral gradient, and increases in mitral valve area. Although minimal randomized data are available, cumulative data from worldwide observational studies suggest postprocedure mitral valve areas may be slightly higher with the double-balloon technique. However, multicenter registry studies suggest a higher incidence of procedural complications with the double-balloon technique. The relative long-term efficacy, complications, and incidence of repeat mitral valve procedures are unknown and likely will never be resolved without a randomized trial. In summary, both Inoue and double-balloon techniques are suitable for performing percutaneous balloon mitral valvuloplasty. The Inoue catheter has clear advantages in terms of technical ease of operation and likely lower complication rates. The possibility of systematically obtaining slightly larger mitral valve areas with the double-balloon technique cannot be ruled out.
已经开发出多种用于经皮二尖瓣球囊成形术的技术。两种方法，即井上导管法和双球囊技术，应用最为广泛。井上手术在技术上更简单，透视时间和手术时间更短。两种手术的急性血流动力学结果都很好，可显著降低左心房压力、跨二尖瓣压差，并增加二尖瓣面积。虽然可用的随机数据极少，但全球观察性研究的累积数据表明，双球囊技术术后的二尖瓣面积可能略高。然而，多中心注册研究表明双球囊技术手术并发症的发生率更高。相对长期疗效、并发症以及二尖瓣再次手术的发生率尚不清楚，而且如果没有随机试验，可能永远无法解决。总之，井上技术和双球囊技术都适用于经皮二尖瓣球囊成形术。井上导管在操作技术简便性方面具有明显优势，并发症发生率可能更低。不能排除双球囊技术系统性获得稍大二尖瓣面积的可能性。
