Hogan K, Ramaswamy K, Losordo D W, Isner J M
Department of Medicine (Cardiology), St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, Massachusetts 02111.
Cathet Cardiovasc Diagn. 1994;Suppl 2:42-51.
Pathologic findings were analyzed in 11 patients who had undergone percutaneous transvenous mitral commissurotomy (PTMC) from 1986 to 1992. Nine valves were obtained at mitral valve replacement and two were obtained at necropsy. These 11 specimens represented all cases studied pathologically among 96 patients undergoing PTMC at a single institution (St. Elizabeth's Medical Center) over this time period. Valvuloplasty was performed using a single balloon in three patients, double balloons in three patients, and the Inoue balloon in five patients. Regardless of the balloon used, fracture of commissural fusion was found to be the fundamental mechanism of success for PTMC. Conditions leading to failure of PTMC included inability to cross the valve, incomplete fracture of commissures, and severe subvalvular disease. Complications included hemodynamically significant atrial septal defect (ASD) and mitral regurgitation (MR). Etiology of MR included failure of leaflet coaptation, ruptured leaflet, and torn chordae, commissure, or papillary muscle. In this selected group of patients, no cases of left ventricular perforation were observed regardless of the technique employed. Hemodynamically significant ASD was observed only with standard single- and double-balloon techniques. MR, restenosis, and failed PTMC were observed with both standard and Inoue techniques.
对1986年至1992年间接受经皮经静脉二尖瓣交界切开术（PTMC）的11例患者的病理结果进行了分析。9个瓣膜是在二尖瓣置换时获得的，2个是在尸检时获得的。这11个标本代表了在这段时间内于单一机构（圣伊丽莎白医疗中心）接受PTMC的96例患者中所有经病理研究的病例。3例患者使用单个球囊进行瓣膜成形术，3例患者使用双球囊，5例患者使用Inoue球囊。无论使用何种球囊，发现交界融合的断裂是PTMC成功的基本机制。导致PTMC失败的情况包括无法穿过瓣膜、交界不完全断裂以及严重的瓣下疾病。并发症包括血流动力学上有意义的房间隔缺损（ASD）和二尖瓣反流（MR）。MR的病因包括瓣叶对合失败、瓣叶破裂以及腱索、交界或乳头肌撕裂。在这组选定的患者中，无论采用何种技术，均未观察到左心室穿孔的病例。仅在标准单球囊和双球囊技术中观察到血流动力学上有意义的ASD。标准技术和Inoue技术均观察到MR、再狭窄和PTMC失败。
