Gupta S, Schiele F, Xu C, Meneveau N, Seronde M F, Breton V, Bernard Y, Bassand J P
Hôpital Universitaire Saint-Jacques, Besançon, France.
Eur Heart J. 1998 Apr;19(4):610-6. doi: 10.1053/euhj.1997.0803.
Percutaneous mitral valvuloplasty with the Inoue balloon is conventionally performed with double vascular access: arterial and venous. However, in patients with a good echogenic window it may be performed with venous access only and the procedure monitored by 2D-echocardiography and colour flow mapping. This should result in early ambulation and hospital discharge with reduced arterial complications.
To compare retrospectively the immediate results of percutaneous mitral valvuloplasty with the Inoue balloon in two groups of patients: Group I: venous access only (no arterial access, n = 102) and Group II: conventional double vascular access (arterial and venous access, n = 275).
The baseline characteristics of the two groups were comparable for age, sex, clinical, echocardiographic, radiological and haemodynamic variables. The mitral valve area (Group I: 1.1 +/- 0.3 to 1.85 +/- 0.5 cm2 vs Group II: 1.05 +/- 0.2 to 1.85 +/- 0.5 cm2, P = ns) and transmitral gradient (Group I: 11 +/- 4 to 4.7 +/- 2 mmHg vs Group II: 12 +/- 4 to 4.8 +/- 2 mmHg, P = ns) before and after mitral valvuloplasty were not statistically different. A good immediate result, defined as mitral valve area > 1.5 cm2 and mean mitral gradient < 5 mmHg with mitral regurgitation < or = 2+ at the end of the procedure, was observed in 77% of the cases in the venous-only group and 79% in the double access group (P = ns). The incidence of severe mitral regurgitation (Grade III or IV) was not statistically significant. Procedural duration (71 +/- 24 min vs 109 +/- 26 min, P < 0.01), fluoroscopic time (12.5 +/- 5.5 min vs 18.5 +/- 6 min, P < 0.01) and hospital stay (2.8 +/- 1.5 days vs 4.8 +/- 2.6 days, P < 0.001) were significantly shorter in the venous-only group than in the conventional Inoue series.
Single venous access balloon mitral valvuloplasty is as equally safe and effective as double vascular access. The additional advantages of single venous access are shorter procedural duration, fluoroscopic time and hospital stay. We recommend that it be performed by an experienced operator (minimum of 100 trans-septal punctures) in patients without major thoracic deformity and a good echogenic window.
传统上，使用Inoue球囊进行经皮二尖瓣成形术需要双血管通路：动脉和静脉通路。然而，对于具有良好超声心动图窗的患者，仅通过静脉通路即可进行该手术，并通过二维超声心动图和彩色血流图进行监测。这应能实现早期下床活动和出院，并减少动脉并发症。
回顾性比较两组患者使用Inoue球囊进行经皮二尖瓣成形术的即刻结果：第一组：仅静脉通路（无动脉通路，n = 102）和第二组：传统双血管通路（动脉和静脉通路，n = 275）。
两组患者在年龄、性别、临床、超声心动图、放射学和血流动力学变量方面的基线特征具有可比性。二尖瓣成形术前和术后的二尖瓣面积（第一组：1.1±0.3至1.85±0.5 cm²，第二组：1.05±0.2至1.85±0.5 cm²，P = 无显著性差异）和跨二尖瓣压差（第一组：11±4至4.7±2 mmHg，第二组：12±4至4.8±2 mmHg，P = 无显著性差异）无统计学差异。在仅静脉通路组中，77%的病例和双通路组中79%的病例观察到良好的即刻结果，定义为二尖瓣面积> 1.5 cm²、平均二尖瓣压差< 5 mmHg且手术结束时二尖瓣反流≤2+（P = 无显著性差异）。严重二尖瓣反流（III级或IV级）的发生率无统计学意义。仅静脉通路组的手术时间（71±24分钟 vs 109±26分钟，P < 0.01）、透视时间（12.5±5.5分钟 vs 18.5±6分钟，P < 0.01）和住院时间（2.8±1.5天 vs 4.8±2.6天，P < 0.001）明显短于传统Inoue系列。
单静脉通路球囊二尖瓣成形术与双血管通路一样安全有效。单静脉通路的额外优点是手术时间、透视时间和住院时间更短。我们建议由经验丰富的操作者（至少100次经房间隔穿刺）对无严重胸廓畸形且具有良好超声心动图窗的患者进行该手术。
