Rangel A, Chávez E, Murillo H, Ayala F
Departamento de Hemodinamia, Hospital de Especialidades, México, D.F.
Arch Med Res. 1998 Summer;29(2):159-63.
The objective of this study is to evaluate the immediate result of the percutaneous mitral valvotomy in patients with previous surgical mitral commissurotomy, compared with patients considered ideal for the performance of the procedure.
The authors of this paper compared the immediate results of the percutaneous mitral valvotomy (PMV) performed on two groups of patients. Group I included 20 patients who were good candidates for PMV, with an echocardiographic score of < or = 8, without evidence of left atrial thrombus, and with no recent embolic event. Group II included seven patients with previous mitral commissurotomy (MC).
According to the Wilcoxon non-parametric t test analysis, the hemodynamic variables changed significantly in the patients of group I: the mitral area increased from 1.21 +/- 0.41 to 2.62 +/- 0.75 cm2 (P = < 0.001); the mean left atrial pressure decreased from 17.2 +/- 7.2 mmHg to 9.2 +/- 4.5 mmHg (P = < 0.001), and the pressure transmitral gradient decreased 12.4 +/- 6.8 to 3.3 +/- 1.26 mmHg (P = < 0.001). No statistically significant difference in the hemodynamic changes of the patients of group II after the PMV was found: the mitral area increased from 1.2 +/- 0.2353 to 1.96 +/- 0.57 cm2; the mean left atrial pressure decreased from 17.42 +/- 10.35 to 12.42 +/- 7.3 mmHg, and the pressure mitral gradient decreased from 11.47 +/- 6.5 to 5.7 +/- 4.8 mmHg. The mitral area determined by echocardiographic procedure showed the same tendency in patients with previous MC.
In spite of this tendency, during the follow-up after PMV the NYHA functional class decreased from II-IV to I in the patients with previous MC. Because a second surgical MC results in higher mortality, PMV is indicated in patients with previous MC, delaying or avoiding a second MC or valve replacement.
本研究的目的是评估经皮二尖瓣球囊成形术对曾接受二尖瓣交界切开术患者的近期疗效，并与被认为适合该手术的患者进行比较。
本文作者比较了两组患者经皮二尖瓣球囊成形术（PMV）的近期疗效。第一组包括20例PMV的理想候选患者，超声心动图评分≤8分，无左心房血栓证据，近期无栓塞事件。第二组包括7例曾接受二尖瓣交界切开术（MC）的患者。
根据Wilcoxon非参数t检验分析，第一组患者的血流动力学变量有显著变化：二尖瓣面积从1.21±0.41cm²增加到2.62±0.75cm²（P＜0.001）；平均左心房压力从17.2±7.2mmHg降至9.2±4.5mmHg（P＜0.001），二尖瓣压力阶差从12.4±6.8mmHg降至3.3±1.26mmHg（P＜0.001）。第二组患者PMV术后的血流动力学变化无统计学显著差异：二尖瓣面积从1.2±0.2353cm²增加到1.96±0.57cm²；平均左心房压力从17.42±10.35mmHg降至12.42±7.3mmHg，二尖瓣压力阶差从11.47±6.5mmHg降至5.7±4.8mmHg。超声心动图检查测定的二尖瓣面积在曾接受MC的患者中显示出相同趋势。
尽管有这种趋势，但在PMV术后的随访期间，曾接受MC的患者纽约心脏协会（NYHA）心功能分级从II-IV级降至I级。由于再次进行外科MC会导致更高的死亡率，因此PMV适用于曾接受MC的患者，可延迟或避免再次进行MC或瓣膜置换。
