二尖瓣形态对经皮球囊二尖瓣成形术近远期疗效的影响

The impact of mitral valve morphology on the short and long-term outcome post percutaneous balloon mitral valvuloplasty in patients with mitral valve stenosis

目的观察不同瓣膜形态的二尖瓣狭窄患者行经皮球囊二尖瓣成形术的近远期疗效。方法根据Wilkins超声二尖瓣形态学积分，将385例二尖瓣狭窄患者分为〉8分组（125例）和≤8分组（260例）。均采用改良Inoue法对患者行经皮球囊二尖瓣成形术。术后进行随访，并比较两组患者的临床疗效。结果经皮球囊二尖瓣成形术成功370例，〉8分组经皮球囊二尖瓣成形术的成功率低于≤8分组（92．8％比97．7％，P〈0．05）。术后6个月，两组患者各项超声心动图检查指标均较术前显著改善（均P〈0．05）；与≤8分组（254例）比较，〉8分组（116例）经皮球囊二尖瓣成形术后左心房平均压、肺动脉收缩压、跨瓣压差及二尖瓣瓣口面积的改变值均较小[分别为（14．22±5．02）mmHg（1mmHg=0．133kPa）比（15．44±5．19）mmHg、（26．13±9．27）mmHg比（31．93±9．98）mmHg、（9．21±4．11）mmHg比（10．16±4．21）mmHg和（1．02±0．15）cm^2比（1．20±0．22）cm^2，均P〈0．05]。经皮球囊二尖瓣成形术成功且完成远期随访[（78±20）个月]的患者共353例，两组患者各项超声心动图检查指标均较术前显著改善（均P〈0．05）；与≤8分组（245例）比较，〉8分组（108例）左心房平均压、肺动脉收缩压、跨瓣压差及二尖瓣瓣口面积的改变值均较小[分别为（13．28±5．06）mmHg比（14．77±5．17）mmHg、（21．19±9．17）mmHg比（28．92±9．91）mmHg、（7．30±4．40）mmHg比（9．16±4．28）mmHg和（0．92±0．17）cm2比（1．07±0．20）cm^2，均P〈0．05]，且再狭窄发生率较高（20．4％比8．2％，P〈0．05）。结论二尖瓣瓣膜形态是决定经皮球囊二尖瓣成形术疗效的关键因素之一。对于超声二尖瓣形态学积分低的患者，经皮球囊二尖瓣成形术成功率较高，术后近期及远期随访疗效较好，再狭窄发生率较低，治疗方案可优先选择经皮球囊二尖瓣成形术。

Objective To investigate the short and long-term outcome post percutaneous balloon mitral valvuloplasty （ PBMV ） in mitral valve stenosis patients with different mitral valve morphology. Methods Mitral valve morphology was graded according to the Wilkins scoring system, 385 eligible patients were divided into echocardiographic scores 〉 8 group （n = 125） and ≤8 group （n = 260）. Patients were followed up after PBMV according to the improved Inoue method. Results PBMV was successful in 370 patients, the success rate of PBMV in 〉 8 group was significantly lower than in ≤8 group （92. 8% vs. 97.7%, P 〈0. 05）. Hemodynamic parameters improved significantly in both groups （all P 〈 0. 05 ） at 6 months post PBMV. Compared to pre-PBMV, improvement on left atrial mean pressure [ （ 14. 22 ~ 5.02） mm Hg vs. （15.44 ± 5.19 ）mm Hg （1 mm Hg = 0. 133 kPa）], pulmonary artery systolic pressure [ （26. 13±9. 27） mm Hg vs. （31.93 ±9. 98） mm Hg], mitral valve gradient [ （9. 21 ±4. 11 ） mm Hg vs. （10. 16±4. 21）mm Hg] and area of mitral valve orifice [ （1.02 ±0. 15） cm2 vs. （1.20 ±0. 22）cm2] post PBMV was less in 〉 8 group （ 116 cases） than those in ≤ 8 group （254 cases, all P 〈 0. 05 ）. Three hundreds and fifty three patients were followed up for （78 ±20） months. Eehocardiographic parameters post PBMV improved significantly in both groups compared with the pre-PBMV values during follow-up （ all P 〈 0. 05）. However, left atrial mean pressure, pulmonary artery systolic pressure, mitral valve gradient and area of mltral valve orifice in 〉 8 group （108 eases） improved less than those in ≤8 group （245 cases） [（13.28±5.06） mmHgvs. （14.77 ±5. 17） mm Hg, （21.19 ±9. 17） mm Hg vs. （28.92 ±9.91） mmHg,（7.30±4.40） mmHgvs. （9.16±4.28） mmHg, （0.92±0.17） em2vs. （1.07±0.20） cm2; all P 〈 0. 051. The incidence of mitral restenosis was also significantly higher in 〉 8 group than in ≤ 8 group （20.4% vs. 8. 2%, P 〈 0. 05 ）. Conclusions The mitral valve morphology played a key role on the outcome post PBMV in patients with mitral valve stenosis. Patients with lower eehocardiographic scores benefit more from PBMV than patients with higher echocardiographie scores.