Arora R, Kalra G S, Murty G S, Trehan V, Jolly N, Mohan J C, Sethi K K, Nigam M, Khalilullah M
Department of Cardiology, G. B. Pant Hospital, New Delhi, India.
J Am Coll Cardiol. 1994 May;23(6):1327-32. doi: 10.1016/0735-1097(94)90374-3.
The purpose of this study was to evaluate the immediate and follow-up results of percutaneous transatrial mitral commissurotomy in 600 patients with rheumatic mitral stenosis.
Percutaneous transatrial mitral commissurotomy has emerged as an effective nonsurgical technique for patients with symptomatic mitral stenosis. Several studies have shown that the immediate results are comparable to closed and open mitral valvotomy.
Percutaneous transatrial mitral commissurotomy was performed in 600 patients with rheumatic mitral stenosis by the double-balloon (290 patients [48.3%]) and flow-guided Inoue balloon (310 patients [51.7%]) techniques. There were 154 male (25.6%) and 446 female (77.4%) patients with a mean [+/- SD] age of 27 +/- 8 years (range 8 to 60). Atrial fibrillation was present in 26 patients (4.3%), mitral regurgitation < or = grade 2 in 62 (10.3%) and densely calcific valve in 12 (2%). All patients had clinical and echocardiographic (two-dimensional, continuous wave Doppler, color flow imaging) follow-up at 3-month intervals.
Percutaneous transatrial mitral commissurotomy was successful in 589 patients (98.1%), and optimal commissurotomy was achieved in 562 (93.6%), with an increase in mitral valve area from (mean +/- SD) 0.75 +/- 0.18 to 2.2 +/- 0.38 cm2 (p < 0.001) and a decrease in transmitral end-diastolic gradient from 27.3 +/- 6.1 to 3.8 +/- 4.2 mm Hg (p < 0.001). Mitral regurgitation developed or increased in 208 patients (34.6%). Six patients (1%) with mitral regurgitation required mitral valve replacement. Cardiac tamponade occurred in 8 patients (1.3%). Six patients (1%) died. Restenosis developed in 10 patients (1.7%) during a mean follow-up period of 37 +/- 8 months (range 6 to 66).
Percutaneous transatrial mitral commissurotomy is an effective, safe procedure with gratifying intermediate results. It should be considered the treatment of choice for rheumatic mitral stenosis.
本研究旨在评估600例风湿性二尖瓣狭窄患者经皮经心房二尖瓣交界切开术的即刻及随访结果。
经皮经心房二尖瓣交界切开术已成为有症状二尖瓣狭窄患者的一种有效的非手术技术。多项研究表明，其即刻结果与闭式和直视二尖瓣切开术相当。
采用双球囊技术（290例患者[48.3%]）和血流导向的Inoue球囊技术（310例患者[51.7%]）对600例风湿性二尖瓣狭窄患者实施经皮经心房二尖瓣交界切开术。男性患者154例（25.6%），女性患者446例（77.4%），平均年龄（±标准差）为27±8岁（范围8至60岁）。26例患者（4.3%）存在心房颤动，62例患者（10.3%）二尖瓣反流≤2级，12例患者（2%）瓣膜重度钙化。所有患者每3个月进行临床及超声心动图（二维、连续波多普勒、彩色血流成像）随访。
589例患者（98.1%）经皮经心房二尖瓣交界切开术成功，562例患者（93.6%）实现了最佳交界切开，二尖瓣瓣口面积从（平均±标准差）0.75±0.18增加至2.2±0.38 cm²（p<0.001），二尖瓣舒张末期跨瓣压差从27.3±6.1降至3.8±4.2 mmHg（p<0.001）。208例患者（34.6%）出现二尖瓣反流或反流加重。6例二尖瓣反流患者（1%）需要进行二尖瓣置换。8例患者（1.3%）发生心脏压塞。6例患者（1%）死亡。在平均37±8个月（范围6至66个月）的随访期内，10例患者（1.7%）出现再狭窄。
经皮经心房二尖瓣交界切开术是一种有效、安全的手术，中期结果令人满意。它应被视为风湿性二尖瓣狭窄的首选治疗方法。
