MITRAL BALLOON VALVULOPLASTY FOR MITRAL RESTENOSIS AFTER SURGICAL COMMISSUROTOMY

[摘要] Mitral balloon valvuloplasty was performed in 14 patients with recurrent mitral stenosis 16.9 .+-. 1.8 years (range 6 to 30) after surgical commissurotomy. There were 13 women and 1 man with a mean age of 55 .+-. 4 years (range 23 to 73). Mitral balloon valvuloplasty resulted in an increase in mitral valve area from 0.8 .+-. 0.1 to 1.7 .+-. 0.2 cm2 (p = 0.001), a decrease in mean mitral diastolic pressure gradient from 15 .+-. 2 to 7 .+-. 1 mm Hg (p = 0.001) and an increase in cardiac output from 3.4 .+-. 0.3 to 3.9 .+-. 0.3 liters/min (p = 0.03). No deaths, strokes, vascular complications or conduction abnormalities were observed. Mitral regurgitation developed or increased in severity in seven patients (50%). There was no evidence of significant left to right shunt through the atrial septal puncture site after mitral balloon valvuloplasty. A good result (defined as a mitral valve area > 1.0 cm2, an increase in mitral valve area > 25% and a mean gradient < 10 mm Hg) was achieved in 9 (64%) of the 14 patients. A subgroup of four patients who had a superior result (increase in migral valve area of 1.7 .+-. 0.2 versus 0.5 .+-. 0.1 cm2 in the other 10 patients, p = 0.004) was identified. These patients had less echocardiographic evidence of rheumatic mitral valve damage and were the only patients who had sinus rhythm. They were also younger, less debilitated and had a lower grade of fluoroscopic valve calcification compared with the other patients. Thus, mitral balloon valvuloplasty is a safe and effective procedure for patients with recurrent mitral stenosis after surgical commissurotomy. A subgroup of younger patients, who have sinus rhythm and less echocardiographic evidence of rheumatic mitral valve damage, has the best outcome with mitral balloon valvuloplasty.

[发布日期] 1988-02-01