In vitro analysis of mechanisms of balloon valvuloplasty of stenotic mitral valves.
In vitro analysis of mechanisms of balloon valvuloplasty of stenotic mitral valves.
复制标题
狭窄二尖瓣球囊成形术机制的体外分析。
DOI：
10.1016/0002-9149(87)90806-x
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发表时间：
1987
期刊：
影响因子：
--
通讯作者：
Salem,DN
中科院分区：
文献类型：
--
作者：
Kaplan,JD;Isner,JM;Karas,RH;Halaburka,KR;Konstam,MA;Hougen,TJ;Cleveland,RJ;Salem,DN
初步报告表明，经皮球囊瓣膜成形术是有效的治疗二尖瓣狭窄。本研究旨在评价老年人二尖瓣狭窄的解剖特征是否影响球囊瓣膜成形术的疗效，并确定实现瓣口面积增加的机制。选择二尖瓣返流不超过2 +/ 4 +的患者在二尖瓣置换术时完整切除的15个二尖瓣进行研究。使用一系列扩张导管进行球囊瓣膜成形术，球囊充盈直径为18 - 25 mm。瓣膜成形术后，使用锥形瓣膜测瓣器测量的二尖瓣面积从0.71 ± 0.06 cm 2（平均值±平均值的标准误）增加至1.77 ± 0.19 cm 2（p < 0.0001），导致计算的瓣口面积增加185 ± 27%（范围34 - 407%）。计算的瓣口面积增加与瓣膜成形术前的瓣口面积呈负相关（r =-0.57; p = 0.026），但与切除二尖瓣的瓣膜成形术前X线片上的钙化沉积程度无关。瓣膜成形术后的大体检查和X线分析显示，每例病例中球囊瓣膜成形术的机制均涉及接合处裂开，包括通过严重钙化的接合处裂开，而没有明显的组织碎片分离。这些结果表明，球囊瓣膜成形术以类似于标准外科连合切开术的方式增加功能性二尖瓣口面积，球囊瓣膜成形术可能对广泛的成人二尖瓣狭窄有效，包括伴有广泛钙化沉积的重度狭窄。
Preliminary reports indicate that percutaneous balloon valvuloplasty is efficacious for treatment of mitral stenosis. The present study was designed to evaluate whether anatomic features of stenotic mitral valves in older adults affect the efficacy of balloon valvuloplasty and to determine the mechanism by which increased orifice area is accomplished. Fifteen mitral valves excised intact at the time of mitral valve replacement from patients with no more than 2 +/ 4 + mitral regurgitation were selected for study. Balloon valvuloplasty was performed using a sequence of dilation catheters with balloons 18 to 25 mm in inflated diameter. Mitral valve area, measured with a conical valve sizer, increased from 0.71 ± 0.06 cm2(mean ± standard error of the mean) to 1.77 ± 0.19 cm2(p < 0.0001) after valvuloplasty, resulting in an increase in calculated orifice area of 185 ± 27% (range 34 to 407%). The increase in calculated orifice area correlated inversely with orifice area before valvuloplasty (r = −0.57; p = 0.026), but was unrelated to extent of calcific deposits on the prevalvuloplasty x-ray of the excised mitral valve. Gross examination together with x-ray analysis after valvuloplasty revealed that the mechanism of balloon valvuloplasty in each case involved commissural splitting, including splits through heavily calcified commissures, without grossly apparent detachment of tissue fragments. These findings suggest that balloon valvuloplasty augments the functional mitral valve orifice area in a manner analogous to standard surgical commissurotomy, and balloon valvuloplastv is likely to be efficacious for a wide spectrum of adult mitral valvular stenosis, including severe stenosis with extensive calcific deposits.