Kotsuka Y, Furuse A, Yagyu K, Kawauchi M, Takeda M, Hirata K
Department of Cardiothoracic Surgery, University of Tokyo, Japan.
Cardiovasc Surg. 1996 Aug;4(4):530-5. doi: 10.1016/0967-2109(95)00116-6.
Percutaneous transvenous mitral commissurotomy is widely performed as the first choice of the non-pharmacological treatments for mitral stenosis. Five patients have been identified who required mitral valve replacement after percutaneous transvenous mitral commissurotomy. The causes leading to mitral valve replacement were mitral regurgitation in three cases and insufficient commissurotomy in two. Massive mitral regurgitation is one of the most serious complications of percutaneous transvenous mitral commissurotomy. This report aims to elucidate the mechanism of massive mitral regurgitation occurring during percutaneous transvenous mitral commissurotomy. In every such case, there was a large tear in the posterior leaflet without any split in the commissures. The Japanese literature reports that 16 patients have undergone mitral valve replacement for massive regurgitation after percutaneous transvenous mitral commissurotomy: 14 of these cases had a tear in one of the leaflets and no evidence of splitting of the posterior commissure. These facts indicate that relative fragility of the leaflets as compared with rigidity of commissural fusion, especially in the posterior commissure, is an important factor of massive mitral regurgitation during percutaneous transvenous mitral commissurotomy.
经皮经静脉二尖瓣交界切开术作为二尖瓣狭窄非药物治疗的首选方法被广泛应用。已确定有5例患者在经皮经静脉二尖瓣交界切开术后需要进行二尖瓣置换术。导致二尖瓣置换的原因是3例二尖瓣反流和2例交界切开不充分。大量二尖瓣反流是经皮经静脉二尖瓣交界切开术最严重的并发症之一。本报告旨在阐明经皮经静脉二尖瓣交界切开术期间发生大量二尖瓣反流的机制。在每一例此类病例中，后叶均有大的撕裂，而交界无任何裂开。日本文献报道，有16例患者在经皮经静脉二尖瓣交界切开术后因大量反流而接受了二尖瓣置换术：其中14例病例的一个瓣叶有撕裂，且无后交界裂开的证据。这些事实表明，与交界融合的刚性相比，瓣叶相对脆弱，尤其是在后交界，是经皮经静脉二尖瓣交界切开术期间大量二尖瓣反流的一个重要因素。
