Thomas M R, Monaghan M J, Michalis L K, Jewitt D E
Department of Cardiology, King's College Hospital, London.
Br Heart J. 1993 May;69(5):418-23. doi: 10.1136/hrt.69.5.418.
(a) To assess the echocardiographic incidence of restenosis after successful balloon dilatation of the mitral valve at a mid-term follow up of one year among a population of predominantly United Kingdom patients. (b) To identify any factors, assessed before or during dilatation, which may predict the development of restenosis.
Successful dilatation of the mitral valve was defined as an increase in mitral valve area of > 25% and a final valve area of at least 1.5 cm2. Echocardiographic restenosis was defined at follow up as a loss of 50% of initial gain and a valve area of less than 1.5 cm2. Mitral valve area was assessed by transthoracic echocardiography before, during, 48 hours after, and one year after successful balloon dilatation of the mitral valve. Echo score before dilatation (an assessment of valvar and subvalvar calcification, thickening, and mobility), age, rhythm, echocardiographic mitral valve area before and after dilatation, left atrial pressure before and after dilatation, and end diastolic mitral valve gradient before and after dilatation were compared in those patients with and without echocardiographic restenosis at one year.
A regional cardiothoracic centre in the United Kingdom that performs 20-30 balloon dilatations of mitral valves each year.
39 patients, with symptomatic dominant mitral stenosis, who had undergone successful balloon dilatation of the mitral valve, and in whom echocardiographic assessment of mitral valve area was available at one year. 92% of patients were citizens of the United Kingdom.
Balloon dilatation of the mitral valve by the Inoue technique.
Mitral valve area and patient symptom class (New York Heart Association) one year after successful dilatation of the mitral valve.
The incidence of echocardiographic restenosis was eight of 39 patients (21%). Of the eight patients with restenosis four underwent mitral valve replacement, two had repeat dilatation of the mitral valve, and two remained on medical treatment. With univariant analysis, factors associated with restenosis were increased age, higher echo score before dilatation, and a lower mitral valve area immediately after the operation. The only independent risk factor for restenosis, shown by multivariant analysis, was a high echo score before dilatation. There was no significant fall in mitral valve area at one year in those patients without restenosis. Most (28/31) of these patients had echocardiographic evidence of splitting of at least one commissure after dilatation compared with only two of eight patients who developed restenosis. Of 10 patients with an echo score before dilatation > or = 10 only two had an initially successful operation and no restenosis at one year.
The echocardiographic incidence of restenosis after dilatation of the mitral valve by the Inoue technique in patients of the United Kingdom is 21%. The principal factor associated with restenosis is a high echo score before dilatation. Increases in mitral valve area are maintained in those patients without restenosis and it is likely that the mechanism of initial increase in valve area is different in the two groups, being commissural splitting in those patients who do not get restenosis and valve stretching in those that do. In patients with an echo score > or = 10 dilatation of the mitral valve should be considered only as a palliative procedure.
（a）在以英国患者为主的人群中，对二尖瓣成功球囊扩张术后一年的中期随访中，评估再狭窄的超声心动图发生率。（b）识别在扩张前或扩张期间评估的任何可能预测再狭窄发生的因素。
二尖瓣成功扩张定义为二尖瓣面积增加>25%且最终瓣膜面积至少为1.5平方厘米。超声心动图再狭窄在随访时定义为初始增加量丧失50%且瓣膜面积小于1.5平方厘米。在二尖瓣成功球囊扩张术前、术中、术后48小时及术后一年，通过经胸超声心动图评估二尖瓣面积。对一年时有无超声心动图再狭窄的患者，比较扩张前的回声评分（对瓣膜及瓣膜下钙化、增厚和活动度的评估）、年龄、心律、扩张前后的超声心动图二尖瓣面积、扩张前后的左心房压力以及扩张前后的舒张末期二尖瓣压差。
英国一家每年进行20 - 30例二尖瓣球囊扩张术的地区心胸中心。
39例有症状的重度二尖瓣狭窄患者，他们接受了二尖瓣成功球囊扩张术，且在一年时可获得二尖瓣面积的超声心动图评估。92%的患者为英国公民。
采用Inoue技术进行二尖瓣球囊扩张。
二尖瓣成功扩张术后一年的二尖瓣面积和患者症状分级（纽约心脏协会）。
39例患者中有8例（21%）发生超声心动图再狭窄。8例再狭窄患者中，4例接受了二尖瓣置换术，2例进行了二尖瓣再次扩张，2例继续接受药物治疗。单因素分析显示，与再狭窄相关的因素有年龄增加、扩张前回声评分较高以及术后即刻二尖瓣面积较低。多因素分析显示，再狭窄的唯一独立危险因素是扩张前回声评分较高。无再狭窄的患者在一年时二尖瓣面积无显著下降。这些患者中的大多数（28/31）在扩张后有超声心动图证据显示至少一个瓣叶交界处裂开，而发生再狭窄的8例患者中只有2例有此情况。扩张前回声评分≥10分的10例患者中，只有2例初始手术成功且一年时无再狭窄。
在英国患者中，采用Inoue技术扩张二尖瓣后，超声心动图再狭窄发生率为21%。与再狭窄相关的主要因素是扩张前回声评分较高。无再狭窄的患者二尖瓣面积得以维持，两组患者瓣膜面积初始增加的机制可能不同，无再狭窄的患者是瓣叶交界处裂开，有再狭窄的患者是瓣膜伸展。对于回声评分≥10分的患者，二尖瓣扩张仅应视为一种姑息性手术。
