Harrison J K, Wilson J S, Hearne S E, Bashore T M
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Cathet Cardiovasc Diagn. 1994;Suppl 2:52-60.
Recent randomized studies have demonstrated that percutaneous transvenous mitral commissurotomy (PTMC) has similar efficacy compared to surgical commissurotomy. Compared with surgery, PTMC is associated with shorter hospital stays, reduced patient discomfort, and significantly lower costs. The challenge of PTMC remains to provide increased safety. The most serious risks of balloon commissurotomy include cardiac perforation and embolic stroke. The creation of severe mitral regurgitation also limits the effectiveness of the procedure and occasionally leads to the requirement for emergency mitral valve replacement. Since 1986, procedure-related mortality has ranged from 0-2.7% with lower mortality rates reported recently. The most frequent cause of procedure-related death has been left ventricular (LV) perforation. This is almost exclusively a complication associated with the double balloon technique, which requires LV guidewires. Cardiac perforation due to inadvertent atrial perforation during transseptal catheterization may occur with the Inoue technique as well, but this tends to be less severe and has not resulted in death. Embolic stroke has occurred in 1.1-5.4% of cases. The incidence of embolic events has been favorably influenced by routine preprocedure transesophageal echocardiography (TEE), eliminating patients with left atrial thrombi. Significant mitral regurgitation occurs in 3.3-10.5% of patients undergoing balloon mitral commissurotomy. Fortunately, mitral regurgitation infrequently requires emergency surgery (0.3-3.3% of cases). Iatrogenic atrial septal defects are usually of no clinical consequence. Their frequency has been reduced with the use of the Inoue balloon catheter system and they rarely require surgical repair.(ABSTRACT TRUNCATED AT 250 WORDS)
近期的随机研究表明，经皮经静脉二尖瓣交界切开术（PTMC）与外科交界切开术疗效相似。与外科手术相比，PTMC具有住院时间短、患者不适感减轻以及成本显著降低的优势。PTMC面临的挑战仍是提高安全性。球囊交界切开术最严重的风险包括心脏穿孔和栓塞性中风。严重二尖瓣反流的产生也限制了该手术的有效性，偶尔还会导致需要紧急进行二尖瓣置换。自1986年以来，与手术相关的死亡率在0%至2.7%之间，近期报告的死亡率较低。与手术相关死亡最常见的原因是左心室（LV）穿孔。这几乎完全是与双球囊技术相关的并发症，该技术需要LV导丝。经房间隔导管插入术期间因意外心房穿孔导致的心脏穿孔在使用Inoue技术时也可能发生，但这种情况往往不太严重，尚未导致死亡。栓塞性中风发生在1.1%至5.4%的病例中。常规术前经食管超声心动图（TEE）对栓塞事件的发生率产生了有利影响，排除了有左心房血栓的患者。在接受球囊二尖瓣交界切开术的患者中，3.3%至10.5%会出现严重二尖瓣反流。幸运的是，二尖瓣反流很少需要紧急手术（0.3%至3.3%的病例）。医源性房间隔缺损通常无临床后果。随着Inoue球囊导管系统的使用，其发生率有所降低，很少需要手术修复。（摘要截取自250词）
