Le Feuvre C, Bonan R, Serra A, Lachurié M L, Lespérance J, Dyrda I, Crépeau J, Vacheron A
Service d'hémodynamie, Institut de cardiologie de Montréal, Québec, Canada.
Arch Mal Coeur Vaiss. 1993 Apr;86(4):407-13.
Fifty nine of the 280 percutaneous mitral valvuloplasties (21%) performed between March 1987 and December 1991 at the Montreal Heart Institute were carried out for symptomatic mitral restenosis 15 +/- 6 years after surgical commissurotomy. The patients were selected according to echocardiographic criteria. The mitral valve disease was comparable to that of patients without previous surgical commissurotomy. Patients with good hemodynamic result had undergone surgical commissurotomy more recently and had less severe valvular damage than patients with an incomplete (n = 10) or poor result (n = 7). One patient died of a cerebral embolism during the procedure, two patients underwent emergency surgery for a mitral valve rupture and 4 patients had an atrial septal defect with Qp/Qs ratio greater than 1.5 by oximetry. The numbers of successes and complications were comparable to those observed in patients without previous surgical commissurotomy. The patients who had undergone previous surgical commissurotomy were followed up for 1 year. At 12 months, 4 remained in Class II of the NYHA classification, 44 (74%) were improved by at least 1 functional class and 10 (17%) had required a mitral valve replacement. Percutaneous mitral valvuloplasty is therefore a useful procedure in patients with moderate degrees of valvular disease who develop restenosis after surgical commissurotomy. A functional improvement can be expected in 3/4 of patients Complications related to the procedure are rare and acceptable compared with the risks of a second thoracotomy. Failure of percutaneous mitral valvuloplasty is generally due to the degree of valvular disease which contraindicated surgical commissurotomy and required mitral valve replacement.
1987年3月至1991年12月间，蒙特利尔心脏研究所对280例患者实施了经皮二尖瓣成形术，其中59例（21%）是针对外科二尖瓣交界切开术后15±6年出现症状性二尖瓣狭窄的患者进行的。这些患者根据超声心动图标准进行选择。其二尖瓣疾病情况与未接受过外科二尖瓣交界切开术的患者相当。血流动力学结果良好的患者较未完全成功（n = 10）或效果不佳（n = 7）的患者，接受外科二尖瓣交界切开术的时间更近，瓣膜损害也较轻。1例患者在手术过程中死于脑栓塞，2例患者因二尖瓣破裂接受了急诊手术；4例患者经血氧测定发现存在房间隔缺损，肺循环血流量与体循环血流量比值大于1.5。成功和并发症的数量与未接受过外科二尖瓣交界切开术的患者观察结果相当。曾接受过外科二尖瓣交界切开术的患者接受了1年的随访。在12个月时，4例患者仍处于纽约心脏协会（NYHA）分级的II级，44例（74%）至少改善了1个功能级别，10例（17%）需要进行二尖瓣置换。因此，经皮二尖瓣成形术对于外科二尖瓣交界切开术后出现狭窄的中度瓣膜病患者是一种有用的治疗方法。预计四分之三的患者功能会得到改善。与再次开胸手术的风险相比，该手术相关并发症罕见且可接受。经皮二尖瓣成形术失败通常是由于瓣膜疾病的程度，这种程度会使外科二尖瓣交界切开术成为禁忌，而需要进行二尖瓣置换。
