Ohnuma N, Kato S, Ohno K, Takasaki K, Okamoto S, Toyoda S, Ogawa K, Nakamoto T, Iizuka M
First Department of Internal Medicine, Dokkyo University School of Medicine, Tochigi, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1997 Mar;35(3):261-6.
We evaluated the therapeutic effect of percutaneous transluminal mitral commissurotomy (PTMC) on pulmonary function, and the damage caused to pulmonary vasculature by transient occlusion of the mitral valve during PTMC in patients with mild mitral stenosis. Pulmonary function tests were done and serum thrombomodulin was measured in 6 patients before and after PTMC. The mean pulmonary arterial pressure and mean pulmonary arterial wedge pressure decreased significantly from the control values, and the decreases were proportional to the increase in the area of the mitral valve. VC, %VC, and DLco were in the normal range before and after PTMC but PEFR, FEV1%, FEV1, V50, V25, and V50/V25 were significantly higher after PTMC. Change in the area of the mitral valve correlated with the changes in FEV1% (r = 0.841), in V50 (r = 0.624), and in V25 (r = 0.697). The serum thrombomodulin levels before and after PTMC did not differ. We conclude that pulmonary dysfunction in patients with mild mitral stenosis MS is mainly due to an obstructive ventilatory defect, and that PTMC can correct this dysfunction without damaging the pulmonary vasculature.
我们评估了经皮腔内二尖瓣交界切开术（PTMC）对肺功能的治疗效果，以及PTMC过程中二尖瓣短暂闭塞对轻度二尖瓣狭窄患者肺血管造成的损害。对6例患者在PTMC前后进行了肺功能测试并检测了血清血栓调节蛋白。平均肺动脉压和平均肺动脉楔压较对照值显著降低，且降低程度与二尖瓣面积增加成正比。PTMC前后VC、%VC和DLco均在正常范围内，但PTMC后PEFR、FEV1%、FEV1、V50、V25及V50/V25显著升高。二尖瓣面积变化与FEV1%变化（r = 0.841）、V50变化（r = 0.624）及V25变化（r = 0.697）相关。PTMC前后血清血栓调节蛋白水平无差异。我们得出结论，轻度二尖瓣狭窄（MS）患者的肺功能障碍主要归因于阻塞性通气缺陷，且PTMC可纠正此功能障碍而不损害肺血管。
