Objectives To assess five-year results after successful percutaneous mechanical mitral commissurotomy (PMMC). Methods Thirty-four selected patients with rheumatic mitral stenosis underwent PMMC successfully in Guangdo...Objectives To assess five-year results after successful percutaneous mechanical mitral commissurotomy (PMMC). Methods Thirty-four selected patients with rheumatic mitral stenosis underwent PMMC successfully in Guangdong cardiovascular institute between February 2001 and August 2002. Serial echocardiograms were performed in all patients at baseline, discharge and annually thereafter. Results Five-year follow-up rate was 97.1%. Five-year survival rate was 100%. Before and after PMMC and at follow-up, mean mitral valve area by two-dimensional echocardiography was (0.87±0.15) cm2, (2.11±0.38) cm2 and (1.81±0.36) cm2, respectively (P<0.01). Five-year mitral restenosis rate was 6.1%. Conclusion PMMC can achieve excellent and sustained long-term results in selected patients with mitral echocardiographic score exceeding or being equal to 9.展开更多
To clarify the contribution of left atrial pressure to the secretion of beta-endorphin, we have investigated the relation between plasma beta endorphin levels and hemodynamic changes in 35 patients with mitral stenosi...To clarify the contribution of left atrial pressure to the secretion of beta-endorphin, we have investigated the relation between plasma beta endorphin levels and hemodynamic changes in 35 patients with mitral stenosis undergoing percutaneous transvenous mitral commissurotomy (PTMC). Before PTMC, plasma beta-endorphin levels obtained from the antecubital vein (28.91 ± 5.59 pg / ml) and from the femoral vein (28.20 ± 5.44 pg / ml) in the patients with mitral stenosis were significantly higher than those obtained from the antecubital vein in the healthy volunteers (22.59 ± 3.86 pg / ml, n = 34, P< 0.001 for each). The levels of beta-endorphin in the femoral vein correlated well with the mean left atrial pressure (r=0.777, P< 0.001) and the mean right atrial pressure (r = 0.450, P<0.01) before the procedure. The antecubital venous levels of beta-endorphin in patients in New York Heart Association functional Classess Ⅱ (26.45 ± 5.39 pg / ml, n = 20) and Ⅲ (32.20 ± 4.02 pg / ml, n = 15) were significantly higher than those in control subjects (P< 0.005 and P< 0.001, respectively). The differences between Classes Ⅱ and Ⅲ were significant (P < 0.001). The plasma levels of beta-endorphin in the patients complicated with atrial fibrillation were also significantly higher than those in patients with normal sinus rhythm (33.31 ± 3.22 pg / ml, n= 13 vs 26.32± 5.07 pg / ml, n = 22, P< 0.001). In ten to fifteen minutes after commissurotomy, plasma levels of beta-endorphin in the femoral vein significantly increased from 28.20 ± 5.44 to 33.14 ± 5.72 pg / ml (P< 0.001). In seventy-two hours after the procedure, plasma beta-endorphin levels in the antecubital vein fell to 24.37 ± 2.59 pg / ml (P< 0.001 vs before PTMC and P<0.05 vs control subjects). Plasma beta-endorphin levels in the patients with atrial fibrillation (26.62 ± 2.36 pg / ml, P< 0.001 vs before PTMC and P< 0.002 vs control subjects) were still higher (P< 0.001) than those in patients with normal shins rhythm (23.05 ± 1.65 pg / ml, P< 0.001 vs before PTMC and P>50 vs control subjects. There was a significant correlation between the levels of beta-endorphin in the antecubital vein and heart rate (r = 0.502, P< 0.001), mean transmitral pressure gradient (r = 0.543, P< 0.001) or mitral valve area (r = -0.710, P< 0.001) before and 72 hours after the procedure.展开更多
Rheumatic heart disease is still highly prevalent in .developing countries where the incidence of coronaryartery disease （CAD） is also arising. Consequently the occurrence of coexistent CAD and mitral stenosis （MS...Rheumatic heart disease is still highly prevalent in .developing countries where the incidence of coronaryartery disease （CAD） is also arising. Consequently the occurrence of coexistent CAD and mitral stenosis （MS） dominantly caused by rheumatic fever is more frequent in these countries. Comorbidities such as pulmonary and renal dysfunction occur frequently in these aging populations. Off-pump surgery is widely applied in patients with concomitant CAD and severe comorbidities due to lower incidence of postoperative morbidity. Closed mitral commissurotomy （CMC） is a well established treatment for patients with mitral stenosis. We report here a case of moderate stenosis combined with seriously diffuse 3-vessel CAD and severe chronic obstructive pulmonary disease （COPD） in an elder male treated with off-pump coronary artery bypass （OPCAB） plus CMC.展开更多
文摘Objectives To assess five-year results after successful percutaneous mechanical mitral commissurotomy (PMMC). Methods Thirty-four selected patients with rheumatic mitral stenosis underwent PMMC successfully in Guangdong cardiovascular institute between February 2001 and August 2002. Serial echocardiograms were performed in all patients at baseline, discharge and annually thereafter. Results Five-year follow-up rate was 97.1%. Five-year survival rate was 100%. Before and after PMMC and at follow-up, mean mitral valve area by two-dimensional echocardiography was (0.87±0.15) cm2, (2.11±0.38) cm2 and (1.81±0.36) cm2, respectively (P<0.01). Five-year mitral restenosis rate was 6.1%. Conclusion PMMC can achieve excellent and sustained long-term results in selected patients with mitral echocardiographic score exceeding or being equal to 9.
文摘To clarify the contribution of left atrial pressure to the secretion of beta-endorphin, we have investigated the relation between plasma beta endorphin levels and hemodynamic changes in 35 patients with mitral stenosis undergoing percutaneous transvenous mitral commissurotomy (PTMC). Before PTMC, plasma beta-endorphin levels obtained from the antecubital vein (28.91 ± 5.59 pg / ml) and from the femoral vein (28.20 ± 5.44 pg / ml) in the patients with mitral stenosis were significantly higher than those obtained from the antecubital vein in the healthy volunteers (22.59 ± 3.86 pg / ml, n = 34, P< 0.001 for each). The levels of beta-endorphin in the femoral vein correlated well with the mean left atrial pressure (r=0.777, P< 0.001) and the mean right atrial pressure (r = 0.450, P<0.01) before the procedure. The antecubital venous levels of beta-endorphin in patients in New York Heart Association functional Classess Ⅱ (26.45 ± 5.39 pg / ml, n = 20) and Ⅲ (32.20 ± 4.02 pg / ml, n = 15) were significantly higher than those in control subjects (P< 0.005 and P< 0.001, respectively). The differences between Classes Ⅱ and Ⅲ were significant (P < 0.001). The plasma levels of beta-endorphin in the patients complicated with atrial fibrillation were also significantly higher than those in patients with normal sinus rhythm (33.31 ± 3.22 pg / ml, n= 13 vs 26.32± 5.07 pg / ml, n = 22, P< 0.001). In ten to fifteen minutes after commissurotomy, plasma levels of beta-endorphin in the femoral vein significantly increased from 28.20 ± 5.44 to 33.14 ± 5.72 pg / ml (P< 0.001). In seventy-two hours after the procedure, plasma beta-endorphin levels in the antecubital vein fell to 24.37 ± 2.59 pg / ml (P< 0.001 vs before PTMC and P<0.05 vs control subjects). Plasma beta-endorphin levels in the patients with atrial fibrillation (26.62 ± 2.36 pg / ml, P< 0.001 vs before PTMC and P< 0.002 vs control subjects) were still higher (P< 0.001) than those in patients with normal shins rhythm (23.05 ± 1.65 pg / ml, P< 0.001 vs before PTMC and P>50 vs control subjects. There was a significant correlation between the levels of beta-endorphin in the antecubital vein and heart rate (r = 0.502, P< 0.001), mean transmitral pressure gradient (r = 0.543, P< 0.001) or mitral valve area (r = -0.710, P< 0.001) before and 72 hours after the procedure.
文摘Rheumatic heart disease is still highly prevalent in .developing countries where the incidence of coronaryartery disease （CAD） is also arising. Consequently the occurrence of coexistent CAD and mitral stenosis （MS） dominantly caused by rheumatic fever is more frequent in these countries. Comorbidities such as pulmonary and renal dysfunction occur frequently in these aging populations. Off-pump surgery is widely applied in patients with concomitant CAD and severe comorbidities due to lower incidence of postoperative morbidity. Closed mitral commissurotomy （CMC） is a well established treatment for patients with mitral stenosis. We report here a case of moderate stenosis combined with seriously diffuse 3-vessel CAD and severe chronic obstructive pulmonary disease （COPD） in an elder male treated with off-pump coronary artery bypass （OPCAB） plus CMC.
