Fatkin D, Roy P, Morgan J J, Feneley M P
Cardiology Department, St. Vincent's Hospital, Sydney, New South Wales, Australia.
J Am Coll Cardiol. 1993 Feb;21(2):390-7. doi: 10.1016/0735-1097(93)90680-y.
The aim of this study was to determine the importance to outcome and the predictability of commissural splitting in patients undergoing percutaneous mitral valvotomy with the Inoue single-balloon catheter.
Echocardiographic scoring systems devised to predict mitral valvotomy outcome are based on assessment of leaflet and subvalvular morphology, but the specific importance of commissural morphology has not been examined.
In 30 consecutive patients, commissural splitting was predicted on the basis of the two-dimensional echocardiographic commissural morphology: the extent of fusion, fibrosis or calcification of each commissure. Valve morphology also was evaluated according to a previously described echocardiographic scoring system.
Splitting of one or both commissures occurred in 24 patients (80%) and was associated with a significantly greater mean increase in valve area (85%) than if neither commissure was split (13%). A good outcome from valvotomy (defined as valve area > 1.5 cm2 and increase in valve area > 25%) was achieved in 96% of those in whom one or both commissures split, but in none of the patients in whom neither commissure split. Whether or not splitting of at least one commissure would occur was predicted accurately in 28 (93%) of the 30 patients. Consequently, the prediction that one or both commissures would split was associated with a good outcome in 23 (89%) of 26 patients, whereas the prediction that neither commissure would split was not associated with a good outcome in any patient. There was no significant difference in the increase in mitral valve area between those with a mitral echocardiographic score < 8 and those with a score > or = 8. New or worsening mitral regurgitation occurred in nine patients, most commonly as a jet directed through a split commissure.
Commissural splitting is the dominant mechanism by which mitral valve area is increased with the Inoue balloon technique, and it can be predicted by echocardiographic assessment of commissural morphology. Commissural morphology is a better predictor of outcome than is the mitral echocardiographic score.
本研究旨在确定经皮使用Inoue单球囊导管进行二尖瓣切开术的患者中，瓣叶联合部裂开对手术结果的重要性及其可预测性。
为预测二尖瓣切开术结果而设计的超声心动图评分系统是基于对瓣叶及瓣下形态的评估，但瓣叶联合部形态的具体重要性尚未得到研究。
连续纳入30例患者，根据二维超声心动图的瓣叶联合部形态预测瓣叶联合部裂开情况：每个瓣叶联合部融合、纤维化或钙化的程度。还根据先前描述的超声心动图评分系统评估瓣膜形态。
24例患者（80%）出现一个或两个瓣叶联合部裂开，与未裂开时相比，瓣膜面积平均增加幅度显著更大（85%对13%）。在一个或两个瓣叶联合部裂开的患者中，96%的患者二尖瓣切开术取得了良好结果（定义为瓣膜面积>1.5 cm²且瓣膜面积增加>25%），而在瓣叶联合部均未裂开的患者中无一例取得良好结果。30例患者中有28例（93%）准确预测了至少一个瓣叶联合部是否会裂开。因此，预测一个或两个瓣叶联合部会裂开的26例患者中有23例（89%）取得了良好结果，而预测瓣叶联合部均不会裂开的患者无一例取得良好结果。二尖瓣超声心动图评分<8分的患者与评分≥8分的患者在二尖瓣面积增加方面无显著差异。9例患者出现新的或加重的二尖瓣反流，最常见的是通过裂开的瓣叶联合部的反流束。
瓣叶联合部裂开是Inoue球囊技术增加二尖瓣面积的主要机制，可通过超声心动图评估瓣叶联合部形态进行预测。瓣叶联合部形态比二尖瓣超声心动图评分更能准确预测手术结果。
