Gao W, Lau K W, Ding Z P, Koh T H, Ardian J S, Goh P P, Quek S, Ng A, Johan A
Singapore Heart Centre, Singapore General Hospital, Singapore.
Singapore Med J. 1996 Aug;37(4):357-61.
Although percutaneous transvenous mitral commissurotomy (PTMC) is currently accepted as the first-line treatment modality for selected patients with mitral stenosis, technical failures and the potential risk of inadvertent cardiac perforation with tamponade, resultant severe mitral regurgitation and death associated with the procedure continue to be important issues of concern.
The purpose of this study was to assess the safety profile and acute results of Inoue-balloon PTMC in a consecutive series of 50 patients with symptomatic significant mitral stenosis who underwent the procedure between January 1993 and August 1994.
PTMC was successfully completed in all patients without encountering cardiac perforation, cardioembolism, severe (> or = grade 3+) angiographic mitral regurgitation or death. The mitral valve area increased from 0.8 +/- 0.2 cm2 to 1.7 +/- 0.4 cm2 (p = 0.0001) as assessed echocardiographically. Optimal results defined as a valve area improvement of > or = 50% and/or a final valve area of > or = 1.5 cm2 without significant mitral regurgitation (> or = 2 grade increase in mitral regurgitation or a final regurgitation > or = 3+) was obtained in 94% of patients.
We confirm that Inoue-balloon PTMC is a safe and highly effective procedure as reflected by the absence of cardiac perforation, cardioembolism, severe mitral regurgitation or death and the excellent enlargement in mitral valve area. Furthermore, in our study the clinical restenosis rate was low with the majority of patients maintaining their improved functional status over a 14-month follow-up period.
尽管经皮经静脉二尖瓣交界切开术（PTMC）目前被公认为特定二尖瓣狭窄患者的一线治疗方式，但技术失败以及手术过程中意外心脏穿孔伴心包填塞、导致严重二尖瓣反流和死亡的潜在风险仍是重要的关注问题。
本研究的目的是评估1993年1月至1994年8月期间连续50例有症状的重度二尖瓣狭窄患者接受Inoue球囊PTMC的安全性和急性疗效。
所有患者PTMC均成功完成，未发生心脏穿孔、心源性栓塞、严重（≥3+级）血管造影二尖瓣反流或死亡。经超声心动图评估，二尖瓣瓣口面积从0.8±0.2cm²增加至1.7±0.4cm²（p = 0.0001）。94%的患者获得了最佳结果，定义为瓣口面积改善≥50%和/或最终瓣口面积≥1.5cm²且无明显二尖瓣反流（二尖瓣反流增加≥2级或最终反流≥3+级）。
我们证实Inoue球囊PTMC是一种安全且高效的手术，这体现在无心脏穿孔、心源性栓塞、严重二尖瓣反流或死亡以及二尖瓣瓣口面积显著扩大。此外，在我们的研究中临床再狭窄率较低，大多数患者在14个月的随访期内维持了改善的功能状态。
