Arora R, Kalra G S, Singh S, Verma P, Satish O S, Nigam M, Cribier A
Department of Cardiology, GB Pant Hospital, New Delhi.
Indian Heart J. 1998 Jan-Feb;50(1):91-5.
Percutaneous transatrial mitral commissurotomy using a new miniaturised metallic commissurotome mounted on a 12 F catheter was done in 24 patients with severe mitral stenosis. There were 17 (70.8%) females and seven (29.2%) males with age ranging from 12-42 years (mean 26.0 +/- 6.7 years). Atrial fibrillation was present in three (12.5%) patients. Three (12.5%) patients had restenosis following closed mitral commissurotomy. The mitral valve score on echocardiography ranged from 6 to 10 (mean 7 +/- 1.3). The procedure was performed with one device which was reused after sterilisation with glutaraldehyde. The device was opened maximally upto 39.0 +/- 1.7 mm (range 35-40 mm). The procedure was successful in 23 (95.8%) patients. The mean left atrial pressure decreased from 26.8 +/- 8.0 to 9.3 +/- 7.1 mm Hg (p < 0.001). There was a fall of mean pulmonary artery pressure from 47.2 +/- 18.6 (range 20-29 mm Hg) to 23.6 +/- 9.6 mm Hg (range 12-51 mm Hg) (p < 0.001). The mitral valve area as assessed by Doppler echocardiography (pressure half time) increased from 0.9 +/- 0.1 (range 0.6-1.2 cm2) to 2.1 +/- 0.4 cm2 (range 1.6-2.6 cm2) (p < 0.001), with split in both commissures in 22 (95.6%) cases. One patient developed severe mitral regurgitation with tear in the anterior mitral leaflet needing immediate mitral valve replacement. One patient developed transient aphasia which recovered completely within four hours. Percutaneous transatrial mitral commissurotomy using metallic commissurotome offers reliable and effective alternative to balloon mitral commissurotomy and may be more cost-effective because of its reusability.
对24例重度二尖瓣狭窄患者采用安装在12F导管上的新型小型金属二尖瓣分离刀进行经皮经心房二尖瓣交界切开术。其中女性17例（70.8%），男性7例（29.2%），年龄12 - 42岁（平均26.0±6.7岁）。3例（12.5%）患者存在心房颤动。3例（12.5%）患者在闭式二尖瓣交界切开术后出现再狭窄。超声心动图二尖瓣评分6 - 10分（平均7±1.3分）。手术使用一个器械，经戊二醛消毒后重复使用。器械最大张开至39.0±1.7mm（范围35 - 40mm）。23例（95.8%）患者手术成功。平均左心房压力从26.8±8.0降至9.3±7.1mmHg（p<0.001）。平均肺动脉压力从47.2±18.6（范围20 - 29mmHg）降至23.6±9.6mmHg（范围12 - 51mmHg）（p<0.001）。经多普勒超声心动图（压力减半时间）评估的二尖瓣面积从0.9±0.1（范围0.6 - 1.2cm²）增加至2.1±0.4cm²（范围1.6 - 2.6cm²）（p<0.001），22例（95.6%）病例两个交界均裂开。1例患者出现严重二尖瓣反流，二尖瓣前叶撕裂，需立即行二尖瓣置换术。1例患者出现短暂性失语，4小时内完全恢复。使用金属二尖瓣分离刀行经皮经心房二尖瓣交界切开术为球囊二尖瓣交界切开术提供了可靠、有效的替代方法，且因其可重复使用可能更具成本效益。
