Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation.
Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation.
复制标题
经皮二尖瓣球囊扩张：与结果和扩张机制相关的超声心动图变量分析。
作者：
G. Wilkins;A. Weyman;V. Abascal;P. Block;I. Palacios
对有风湿性二尖瓣狭窄病史的 22 名患者（4 名男性，18 名女性，平均年龄 56 岁，范围 21 至 88 岁）在二尖瓣球囊扩张前后进行横断面超声心动图研究。对扩张前超声心动图上二尖瓣的外观进行小叶活动度、小叶增厚、瓣下增厚和钙化评分。还研究了二尖瓣面积、左心房容积、二尖瓣压差、肺动脉压、心输出量、心律、纽约心脏协会功能分级、年龄和性别。由于几乎所有患者的瓣膜面积都有所增加，因此结果被分类为最佳或次优（最终瓣膜面积小于 1.0 cm2，最终左心房压力大于 10 mm Hg，或最终瓣膜面积比初始面积大不到 25%）。仅用总超声心动图评分即可找到最佳的多重逻辑回归拟合。高分（严重的小叶畸形）与次优结果相关，而低分（活动瓣膜增厚有限）与最佳结果相关。在此分析中，没有出现其他血流动力学或临床变量作为结果的预测因子。扩张前和扩张后超声心动图检查表明，球囊扩张可靠地导致连合平面的劈裂，从而增加瓣膜面积。
Twenty two patients (four men, 18 women, mean age 56 years, range 21 to 88 years) with a history of rheumatic mitral stenosis were studied by cross sectional echocardiography before and after balloon dilatation of the mitral valve. The appearance of the mitral valve on the pre-dilatation echocardiogram was scored for leaflet mobility, leaflet thickening, subvalvar thickening, and calcification. Mitral valve area, left atrial volume, transmitral pressure difference, pulmonary artery pressure, cardiac output, cardiac rhythm, New York Heart Association functional class, age, and sex were also studied. Because there was some increase in valve area in almost all patients the results were classified as optimal or suboptimal (final valve area less than 1.0 cm2, final left atrial pressure greater than 10 mm Hg, or final valve area less than 25% greater than the initial area). The best multiple logistic regression fit was found with the total echocardiographic score alone. A high score (advanced leaflet deformity) was associated with a suboptimal outcome while a low score (a mobile valve with limited thickening) was associated with an optimal outcome. No other haemodynamic or clinical variables emerged as predictors of outcome in this analysis. Examination of pre-dilatation and post-dilatation echocardiograms showed that balloon dilatation reliably resulted in cleavage of the commissural plane and thus an increase in valve area.