Gupta S, Vora A, Lokhandwalla Y, Kerkar P, Gupta S, Kulkarni H, Dalvi B
King Edward VII Memorial (KEM) Hospital, Bombay, India.
Eur Heart J. 1996 Oct;17(10):1560-4. doi: 10.1093/oxfordjournals.eurheartj.a014721.
Mitral restenosis often occurs within 5 to 15 years of surgical valvotomy. Percutaneous balloon mitral valvotomy is well established as a safe and effective alternative to mitral stenosis surgery, but only a few small studies have reported on the procedure.
(i) To evaluate the safety and efficacy of percutaneous balloon mitral valvotomy in patients with mitral restenosis. (ii) To evaluate the intermediate-term outcome of patients undergoing balloon mitral valvotomy after previous surgical valvotomy. (iii) To compare these patients with those undergoing balloon mitral valvotomy as the initial procedure.
We analysed our experience of 614 consecutive patients undergoing balloon valvotomy and identified 84 patients (13.7%) with mitral restenosis following prior surgical valvotomy (Group I). The remaining 530 patients (86.3%) had not undergone previous surgery (Group II). The incidence of atrial fibrillation (19% vs 5.6%), mitral valve calcification (50% vs 30.6%) and total echo score > 8 (54.8% vs 24.15%) was significantly higher in Group I. Both groups were comparable as regards their functional class, technique of valvotomy, mitral valve area (0.87 +/- 0.18 vs 0.87 +/- 0.15 cm2, P = ns), mean transmitral gradient (19.63 +/- 6.01 vs 19.21 +/- 5.67 mmHg, P = ns), and mean pulmonary artery pressure (42.2 +/- 19.0 vs 40.8 +/- 14.4 mmHg, P = ns).
After percutaneous balloon mitral valvotomy, the final mitral valve area (1.67 +/- 0.28 vs 1.69 +/- 0.29 cm2, P = ns), mean transmitral-mitral gradient (6.12 +/- 3.68 vs 5.02 +/- 3.21 mmHg, P = ns) and mean pulmonary artery pressure (31.0 +/- 15.2 vs 28.5 +/- 11.1 mmHg, P = ns) were comparable. The success rate (93.0% vs 95.3%, P = ns) were similar in both groups. Significant mitral regurgitation was seen in four (4.8%) patients in Group I and 22 (4.1%) patients in Group II (P = ns). There were two deaths (2.4%) in Group I and five (0.9%) in Group II (P = ns). The clinical and echo Doppler follow-up (8-40 months) studies showed that both groups were of similar NYHA class, and had similar mitral valve area (1.65 +/- 0.21 vs 1.66 +/- 0.3 cm2) and transmitral gradients (7.1 +/- 3.8 vs 5.9 +/- 3.5 mmHg).
We conclude that percutaneous balloon mitral valvotomy can be performed safely and effectively in patients with mitral restenosis following surgical valvotomy; the beneficial acute outcome is sustained, as shown at intermediate-term follow-up and is similar to that of patients undergoing balloon mitral valvotomy as an initial procedure.
二尖瓣再狭窄常发生在外科瓣膜切开术后5至15年。经皮气球二尖瓣成形术已被公认为是二尖瓣狭窄手术的一种安全有效的替代方法，但仅有少数小型研究报道过该手术。
（i）评估经皮气球二尖瓣成形术治疗二尖瓣再狭窄患者的安全性和有效性。（ii）评估既往接受过外科瓣膜切开术的患者接受气球二尖瓣成形术的中期结局。（iii）将这些患者与接受初次气球二尖瓣成形术的患者进行比较。
我们分析了连续614例接受气球瓣膜成形术患者的经验，确定了84例（13.7%）既往接受过外科瓣膜切开术后出现二尖瓣再狭窄的患者（I组）。其余530例患者（86.3%）未接受过既往手术（II组）。I组心房颤动发生率（19%对5.6%）、二尖瓣钙化发生率（50%对30.6%）和总回声评分>8的发生率（54.8%对24.15%）显著更高。两组在功能分级、瓣膜成形技术、二尖瓣瓣口面积（0.87±0.18对0.87±0.15cm²，P=无显著性差异）、平均跨二尖瓣压差（19.63±6.01对19.21±5.67mmHg，P=无显著性差异）和平均肺动脉压（42.2±19.0对40.8±14.4mmHg，P=无显著性差异）方面具有可比性。
经皮气球二尖瓣成形术后，最终二尖瓣瓣口面积（1.67±0.28对1.69±0.29cm²，P=无显著性差异）、平均跨二尖瓣压差（6.12±3.68对5.02±3.21mmHg，P=无显著性差异）和平均肺动脉压（31.0±15.2对28.5±11.1mmHg，P=无显著性差异）具有可比性。两组成功率（93.0%对95.3%，P=无显著性差异）相似。I组4例（4.8%）患者和II组22例（4.1%）患者出现显著二尖瓣反流（P=无显著性差异）。I组有2例死亡（2.4%），II组有5例死亡（0.9%）（P=无显著性差异）。临床和超声多普勒随访（8 - 40个月）研究表明，两组纽约心脏协会分级相似，二尖瓣瓣口面积（1.65±0.21对1.66±0.3cm²）和跨二尖瓣压差（7.1±3.8对5.9±3.5mmHg）相似。
我们得出结论，经皮气球二尖瓣成形术可安全有效地应用于外科瓣膜切开术后二尖瓣再狭窄患者；中期随访显示有益的急性结局得以维持，且与接受初次气球二尖瓣成形术的患者相似。
