Goel P K, Garg N, Sinha N
Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Cathet Cardiovasc Diagn. 1998 Feb;43(2):141-6. doi: 10.1002/(sici)1097-0304(199802)43:2<141::aid-ccd7>3.0.co;2-a.
Mitral regurgitation (MR) is a known complication of Inoue balloon mitral commissurotomy (BMC) and has been variously ascribed to the presence of severe subvalvular pathology (SVP), preexisting MR, calcification, or oversizing. The pressure zone used--with the low pressure zone (LPZ) the lower half of the spectrum of sizes available out of a single balloon, and the high pressure zone (HPZ) the upper two levels, i.e., within 2 mm of its maximum size--could have a bearing on the occurrence of MR, but has not been studied before. We analysed 251 consecutive patients (mean age 28.6 + 9.7 years), undergoing BMC from October 1993 onwards, with pliable, non-calcific, splittable (bilateral dark zones present) valves with not more than trivial MR (1 + in grades of 1-4). Balloon sizing was done with standard formula using height with stepwise dilatation starting 2 mm below the reference size. Thirty-two patients additionally had severe SVP. Patients were divided into two groups, HPZ-BMC and LPZ-BMC, depending upon the final balloon size needed for a successful result. Incidence of MR (2+ or more) was significantly lower in the LPZ BMC (18%) vs. HPZ BMC (32.2%) (P < 0.05). Moderate to severe MR (3+/4+) was also less in LPZ BMC (2.8%) vs. HPZ BMC (8.2%) (P < 0.05). Amongst patients with severe SVP, 3/15 (20%) developed MR in the LPZ-BMC group (all mild only) as against 8/17 (42%) (P < 0.05) in the HPZ-BMC group with half of them having moderate to severe MR. In 54 patients where the reference size had to be exceeded, no patient (0/8) developed MR as long as the higher size was in the LPZ of the particular balloon used as compared to 17/46 (36.9%) who developed MR when the size used fell in the HPZ. We conclude that the pressure zone used has a strong bearing on the occurrence of MR in Inoue BMC and that a low-pressure strategy could avoid MR.
二尖瓣反流（MR）是已知的井上球囊二尖瓣交界切开术（BMC）的并发症，其病因有多种，包括严重的瓣下病变（SVP）、术前存在的MR、钙化或球囊尺寸过大。所使用的压力区——单个球囊可用尺寸范围的下半部分为低压区（LPZ），上两个级别为高压区（HPZ），即最大尺寸的2毫米范围内——可能与MR的发生有关，但此前尚未进行过研究。我们分析了1993年10月起连续接受BMC的251例患者（平均年龄28.6±9.7岁），这些患者的瓣膜柔韧、无钙化、可分裂（存在双侧暗区）且MR不超过轻度（1-4级中的1+）。使用标准公式根据身高进行球囊尺寸计算，并从参考尺寸以下2毫米开始逐步扩张。另外有32例患者存在严重SVP。根据成功结果所需的最终球囊尺寸，将患者分为两组，即高压区BMC组和低压区BMC组。低压区BMC组MR（2+或更高）的发生率（18%）显著低于高压区BMC组（32.2%）（P<0.05）。低压区BMC组中重度MR（3+/4+）的发生率（2.8%）也低于高压区BMC组（8.2%）（P<0.05）。在存在严重SVP的患者中，低压区BMC组有3/15（20%）发生MR（均为轻度），而高压区BMC组为8/17（42%）（P<0.05），其中一半为中重度MR。在54例必须超过参考尺寸的患者中，只要使用的较大尺寸处于所用特定球囊的低压区，就没有患者（0/8）发生MR，而当使用的尺寸处于高压区时，有17/46（36.9%）的患者发生MR。我们得出结论，所使用的压力区对井上BMC中MR的发生有很大影响，采用低压策略可避免MR。
