经皮球囊肺动脉瓣成形术治疗婴儿和新生儿肺动脉瓣狭窄及闭锁

探讨经皮球囊肺动脉瓣成形（PBPV）术治疗婴儿和新生儿肺动脉瓣狭窄（PS）及室间隔完整型肺动脉瓣闭锁（PA/IVS）的安全性及有效性。方法　2006年1月至2009年4月,广东省心血管病研究所心儿科收治PS及PA/IVS婴儿和新生儿63例。其中危重新生儿20例（31.7％）。术前经超声心动图确诊为PS 56例,PA/IVS 7例。危重新生儿PS需先用直径2.5～4.0 mm小球囊预扩张肺动脉瓣,PA/IVS患儿需先行射频瓣膜打孔术。PBPV术所选球囊直径为肺动脉瓣环径（PVAD）1.2～1.3倍（新生儿所选球囊直径为PVAD 1.0～1.2倍）。结果　全组63例（100％）PBPV术成功。球囊径/瓣环径：1.2±0.1。右室压力明显下降[术前（104.3±32.7） mmHg（1 mmHg = 0.133kPa）,术后（52.0±10.5） mmHg,P < 0.001],跨肺动脉瓣压力阶差明显下降[术前（99.2±23.5） mmHg,术后（27.7±12.4）mmHg,P < 0.001]。平均手术时间（88.1±36.2） min,平均X线曝光时间（16.9±11.1） min。术中6例（9.5％）出现并发症,2例心包积液,2例低氧血症,1例三尖瓣腱索部分撕裂, 1例室上性心动过速。平均随访（19.0±12.3）个月,3例术后因残余中度或重度PS,3个月后再次行PBPV术。本组所有患儿肺动脉瓣仅轻度反流。结论　PBPV术治疗婴儿和新生儿PS及PA/IVS安全、有效。     

经皮球囊肺动脉瓣成形术对患儿心肌细胞的影响

目的了解经皮球囊肺动脉瓣成形术(PBPV)前后不同时间点血浆心肌钙蛋白 I以及肌酸磷酸激酶同工酶MB(CK MB)水平的动态变化，以此来评估该治疗方法对患儿心肌细胞的影响。 方法2004 01—2005 06在南京市儿童医院接受PBPV的肺动脉瓣狭窄患儿18例，通过酶联免疫吸附法以及免疫抑制法分别测定18例先天性肺动脉瓣狭窄患儿在行球囊扩张治疗不同时间点血浆心肌钙蛋白 I和CK MB水平。 结果术后心肌钙蛋白 I水平明显升高，术后即刻所测心肌钙蛋白 I达到所有时间点的峰值［为(1.34±0.32)μg/L］，而1d后绝大多数患儿心肌钙蛋白 I仍维持在术后即刻水平，术后3d已显著下降［为(0.43±0.20)μg/L］，与术前［(0.31±0.11)μg/L］相比差异已无显著性。CK MB于术后即刻也明显升高［为(44.7±8.9)U/L］，与术前［为(24.2±7.10)U/L］相比差异有显著性，而术后1d则明显下降，于术后3d降至术前水平［为(27.2±5.3)U/L］。 结论经皮球囊肺动脉瓣成形术存在对心肌细胞的损伤作用，但这种损伤是暂时的、可逆的。     

经导管膜周部室间隔缺损封堵术并发三尖瓣损伤8例临床分析

摘要：目的　分析经导管膜周部室间隔缺损（PMVSDs）封堵术并发三尖瓣损伤原因，探讨其预防及处理措施。 方法　2002年10月至2009年12月广东省心血管病研究所825例PMVSDs患儿，均进行了经导管介入封堵，其中8例出现三尖瓣损伤。8例患儿中男4例，女4例；年龄3.5～8.0岁。8例三尖瓣损伤患儿中4例出现三尖瓣狭窄，其中2例严重狭窄者行外科手术治疗，术中见封堵器右室盘与三尖瓣腱索缠绕，予松开缠绕、取出封堵器并修补室间隔缺损；2例轻度狭窄者予随诊观察。8例中其余4例出现三尖瓣关闭不全，其中3例反流严重予外科手术治疗，术中见三尖瓣腱索断裂1例，腱索断裂并瓣膜撕裂1例，三尖瓣隔瓣腱索被封堵器牵拉1例。术中将断裂的腱索缝合，取出封堵器并修补室缺，合并三尖瓣撕裂者行三尖瓣整形。余1例三尖瓣隔瓣脱垂并轻至中度反流的病例予随诊。结果　5例外科手术治疗者中，4例三尖瓣功能恢复良好，1例三尖瓣血流速度稍增快。三尖瓣损伤不重未行外科处理的3例病例随诊1月至2年，三尖瓣病变无加重，患儿无明显临床症状。结论　经导管PMVSDS封堵术并发三尖瓣损伤有多方面原因。操作中应避免轨道钢丝穿过三尖瓣腱索，出现腱索与封堵器或输送钢缆缠绕时切勿使用暴力牵拉。三尖瓣损伤严重时应外科手术治疗。     

冠状动脉异常分布对小儿复杂先心病右室流出道重建的影响

目的总结法洛四联症和右室双出口合并冠状动脉畸形手术治疗经验，探讨冠状动脉畸形对右室流出道重建的影响。方法1989年4月至2004年5月治疗合并冠状动脉畸形的法洛四联症和右室双出口患儿20例，其中单支冠状动脉畸形11例，左前降支起自右冠状动脉6例，右冠状动脉 肺动脉瘘2例，左右冠状动脉交通支形成蔓状血管丛1例。行姑息手术1例，根治术19例。结果根治术早期死亡1例，18例随访10个月至8年，残余漏2例，残余梗阻3例，余结果满意。结论根据畸形冠状动脉走行特点，选择手术切口，避免损伤异常冠状动脉。有些术中被迫使用异体材料或无法行根治术，影响了中远期效果，应引起足够重视。     

动脉转位术后左心室功能和大动脉发育的中期随访观察

目的观察动脉转位术(ASO)治疗复杂先天性心脏病术后早中期超声心动图的随访结果，评价该手术后左心室的功能和大动脉的发育。 方法2000年10月至2004年3月，复旦大学儿科医院对实施ASO后4~37(19.6±11.1)个月的16例患儿进行超声心动图检查，其中室间隔完整的完全性大动脉转位(TGA/IVS)8例，完全性大动脉转位合并室间隔缺损(TGA/VSD)6例，右室双出口合并肺动脉瓣下室间隔缺损(Taussig-Bing畸形)2例。将获取的资料与正常参考值作比较。 结果左室短轴缩短率(LVSF)为(38.10±5.90)%，其中14例(87.5%)在正常范围，2例(12.5%)大于正常范围；左室射血分数(LVEF)为(69.16±7.01)%，均在正常范围。主动脉根部直径平均较正常值扩大(5.5±3.2)mm，其中14例(87.5%)大于正常值95%可信区间的上限；瓣环直径较正常值平均扩大(3.6±3.3)mm，其中10例(62.5%)大于正常值95%可信区间的上限。主肺动脉直径较正常值平均小(1.3±1.5)mm，其中9例(56.25%)在正常值95%可信区间内；瓣环直径较正常值平均小(1.1±1.7)mm，其中10例(62.5%)在正常值95%可信区间内。6例存有主动脉瓣轻度反流；肺动脉瓣上狭窄极轻度3例，轻度狭窄1例；2例存有肺动脉瓣轻度反流。 结论超声心动图随访结果证实目前在本中心开展ASO治疗TGA等复杂性先天性心脏病术后左心室功能良好，新主动脉根部和瓣环有所扩张，新肺动脉根部和瓣环发育良好。     

碳酸钙混悬液治疗儿童原发性胆汁反流性胃炎的疗效观察

目的观察碳酸钙混悬液治疗儿童原发性胆汁反流性胃炎的疗效。 方法2004-10—2006-10，对浙江大学医学院附属儿童医院经胃镜和24h动态胆红素监测仪(Bilitec 2000)确诊为原发性胆汁反流性胃炎的32例患儿，随机分成两组：A组15例，给予碳酸钙混悬液治疗4周；B组17例，给予碳酸钙混悬液加多潘立酮治疗4周，分别于治疗前及治疗2周、4周时观察患儿腹痛、腹胀、恶心、呕吐等症状积分变化，并于治疗4周后停药3d复查胃内24h胆汁反流情况。 结果两组治疗4周后各症状积分较治疗前均有明显下降，差异有统计学意义(P<0.05)；两组间治疗后各症状积分下降值比较，差异无统计学意义(P>0.05)。两组患儿治疗4周后24h胃内胆汁反流监测各指标与治疗前相比差异均无统计学意义(均为P>0.05)。 结论碳酸钙混悬液对缓解儿童原发性胆汁反流性胃炎症状有明显疗效，但不能有效阻止胆汁反流，合用多潘立酮并无增效作用。     

超声新指标和脑利钠肽评估小儿室间隔缺损 合并肺动脉高压右室功能损害价值分析

目的    探讨组织多普勒（TDI）、二维斑点追踪技术（STI）和血清脑利钠肽（BNP）评估室间隔缺损（VSD）合并不同程度肺动脉高压（PH）患儿右心室功能的价值。方法    2008年6月至2010年6月在苏州大学附属儿童医院住院的VSD合并PH患儿68例,根据三尖瓣反流压差测得肺动脉压力程度分为轻度组（23例）、中度组（21例）、重度组（24例）。同时选择24名健康体检者作为正常对照组。采用GE VIVID7仪器测量右室长轴整体收缩期应变（GLS）和应变率（GLSR）,三尖瓣环脉冲组织多普勒图测量三尖瓣环收缩期峰值速度（Sa）、等容收缩加速度（IVA）、Tei指数,用M型超声测量三尖瓣环收缩期位移（TAPSE）。采用ELIASA法测血清脑钠钛（BNP）浓度。结果    （1） IVA和TAPSE随着PAH升高而降低,而Tei指数随着PAH增加而增大,3个指标除正常对照组和轻度组间差异无统计学意义外（P > 0.05）,其他各组间差异均有统计学意义（P < 0.05）。Sa在中、重度组间差异无统计学意义（P > 0.05）,在正常对照、轻度组间差异无统计学意义（P > 0.05）,其余组间有统计学意义（P < 0.05）。（2）右室GLS、GLSR随着PAH升高而减小,GLS在4组间两两比较差异有统计学意义（P < 0.05）;GLSR中度和重度组与正常对照组和轻度组差异有统计学意义（P < 0.05）,中重度间及正常对照组和轻度间差异无统计学意义（P>0.05）。（3）血清BNP浓度在VSD组中随着PAH程度的加重而升高,在4组间两两比较差异有统计学意义（P < 0.05）。（4）BNP与Tei指数及心功能分级相关性最好。结论    TDI和STI各个参数均能反映VSD合并PH患儿右心室功能,其中BNP和Tei指数与心功能相关性最好,而BNP和GLS可以反映轻度PAH时右室功能受损。     

第二代动脉导管未闭封堵器封堵 特殊类型室间隔缺损2例报告

目的　总结分析应用第二代动脉导管未闭封堵器（ADO-Ⅱ）对特殊类型室间隔缺损（VSD）封堵的技巧。方法　研究对象为2011年8月至9月在上海交通大学医学院附属上海儿童医学中心行介入治疗的患儿2例,因应用常规VSD封堵器封堵困难,遂选取ADO-Ⅱ进行治疗。常规建立动静脉轨迹后,采用主动脉内释放,然后行左室、升主动脉造影和心脏超声检查,如封堵器位置好,无残余分流、瓣膜反流则释放。结果　例1左室造影显示为膜周VSD,左室面7.6 mm,较大假性室隔瘤形成,右室分流口弥散,最大约2.3 mm,缺损上缘距主动脉为6.1 mm。导丝建轨后,7 F长鞘无法通过分流口,最后选用5F长鞘,“6 mm×4 mm”的ADO-Ⅱ封堵成功,术后心脏超声三尖瓣轻微分流。例2心室造影为肌部VSD,左室面6.3 mm,右室分流口为2 mm,上缘距主动脉16 mm。因VSD走行异常且分流口小,最终选冠脉导丝建轨成功,应用4 F长鞘,“4 mm×4 mm”ADO-Ⅱ封堵成功。2例患儿术后1d复查心脏超声和心电图,无异常,观察5 d后出院随访,并口服阿司匹林［3～5 mg/（kg·d）］。结论　对于一些形态较特殊的VSD,常规VSD封堵器无法成功封堵时,可选择ADO-Ⅱ进行封堵,手术操作简单、安全、可靠而并发症少。     

双胎输血综合征选择性胎儿镜激光凝固手术前后胎儿心肌力学的研究

目的 探讨双胎输血综合征(TTTS)选择性胎儿镜激光凝固术(SFLP)前后供血胎儿和受血胎儿的心肌力学改变.方法 2007年10月至2010年3月对25例TTTS孕妇行SFLP,手术前24h和手术后1周行胎儿超声心动图检查,并采集胎儿二维标准四腔心数字化图像,用速度矢量成像(VVI)软件分析心脏左室和右室长轴方向的心肌应变、收缩期应变率(SRs)和舒张期应变率(SRd).结果 与术前比较,SFLP术后,供血胎儿心胸比增大(分别为0.29±0.03、0.34±0.05,P＜0.01),出现三尖瓣反流(7例)和心包积液(5例),心肌力学方面:左室和右室的心肌应变、SRs和SRd均明显减低[左室心肌应变:(-19.24±3.68)％、(-13.78±3.64)％,P＜0.01;左室SRs:(-2.28±0.53)、(-1.43±0.41)s-1,P＜0.01;左室SRd:(1.67±0.43)、(1.15±0.70) s-1,P＜0.01;右室心肌应变:(-20.20±3.19)％、(- 16.10±3.07)％,P＜0.01;右室SRs:(-2.03 ±0.65)、(-1.72±0.38) s-1,P＜0.05;右室SRd:(1.71±0.30)、(1.50±0.36) s-1,P＜0.05];而受血胎儿心胸比减小(分别为0.42±0.04、0.37±0.04,P＜0.01),左室和右室的心肌应变、SRs和SRd均明显升高[左室心肌应变:(-10.62±2.72)％、(- 16.46±3.23)％,左室SRs:(-1.09±0.30)、(-1.60±0.31)s-1,左室SRd:(0.99±0.34)、(1.53±0.32) s-1,右室心肌应变:(- 11.66±4.56)％、(- 17.96±3.97)％,右室SRs:(- 1.26±0.39)、(- 1.74±0.45)s-1,右室SRd:(1.15±0.49)、(1.63±0.44)s-1;P＜均0.01].结论 SFLP术后短时间内(1周),受血胎儿的心功能明显得到改善,而供血胎儿心功能则减退.     

主动脉弓离断21例临床分析

目的分析主动脉弓离断(IAA)的发病情况，总结诊断和治疗经验。 方法回顾性分析复旦大学附属儿童医院1995—2004年收治的21例IAA患儿的临床资料。 结果21例IAA患儿年龄在12d至11岁(中位数1.5个月)，男11例，女10例。占同期先天性心脏病患儿的0.1%。其中A型18例(占85.7%)，B型3例(占14.3%)，无C型病例。所有病例均合并粗大动脉导管未闭及大型室间隔缺损，其它伴发畸形包括继发孔房间隔缺损、主动脉瓣单瓣或两瓣畸形、主动脉瓣下狭窄。超声心动图明确诊断10例，提示IAA或重度缩窄8例，未提示主动脉弓病变3例，漏诊率为14.3%。21例中3例超声心动图诊断比较明确且患儿心功能差，未做心导管检查直接手术治疗，术中发现与超声心动图一致；9例施行手术治疗；2例分期手术均为年长儿，手术效果理想；余7例施行一期根治术(6例为3个月以下婴儿，1例为5岁男孩)，其中4例手术顺利，术后恢复好，3例围手术期死亡，死亡原因分别为术后室颤、鱼精蛋白过敏和术后严重肺炎呼吸衰竭。 结论超声心动图为初步诊断IAA的重要方法，但有一定漏诊率，确诊宜结合心导管检查及心血管造影；婴儿期治疗采取一期根治术，病死率仍较高，围手术期并发症是导致死亡主要原因。     

Successful balloon pulmonary valvuloplasty for congenital valvular pulmonary stenosis in an octogenarian.

While balloon valvuloplasty has been widely used for the treatment of congenital valvular pulmonary stenosis (PS) in children and adults, its use in elderly patients is less common. An 80-year-old woman with congenital valvular PS received valvuloplasty with double-balloon technique. Right ventricle systolic pressure and pulmonary valve systolic pressure gradient decreased from 95 to 44 mm Hg and from 75 to 35 mm Hg, respectively. Follow-up Doppler echocardiography 2 months later showed further decrease in the transvalvular systolic pressure gradient to 29 mm Hg. The patient had symptomatic relief, and no major complication was noted. Balloon pulmonary valvuloplasty can be an effective treatment for elderly patients with congenital valvular PS.     

Pulmonary balloon valvuloplasty in a fetus with critical pulmonary stenosis/atresia with intact ventricular septum and heart failure

Outcome of fetuses with critical pulmonary stenosis (critical PS) or atresia of the pulmonary valve (PA) with intact ventricular septum (IVS) is closely related with right ventricle hypoplasia and its consequent hemodynamics. Fetal echocardiography not only allows early detection of this condition but also monitors its normally unfavorable evolution. These cases may benefit from intrauterine intervention relieving outflow tract obstruction in order to achieve a biventricular circulation. Successful valvuloplasty of the pulmonary valve was performed in a fetus with critical PS-IVS and heart failure at 25 weeks. After the procedure there was a significant improvement in fetal hemodynamics. Follow-up scans at 34 weeks detected a significant restenosis with signs of circulatory failure leading to premature delivery of the baby. An immediate postnatal valvuloplasty successfully completed the ultimate objective of biventricular repair. Fetal pulmonary valvuloplasty is feasible and may change the natural history of the disease in fetuses with critical PS-IVS.     

In utero progressive pulmonary stenosis successfully treated with transcatheter intervention after delivery.

It is unclear whether pulmonary stenosis with intact ventricular septum is a secondary cardiac malformation. We report an infant with pulmonary stenosis (diagnosed by fetal echocardiography) with progressive obstruction in late gestation who presented with increasing transvalvular pressure gradients (15 mm Hg at 22 weeks' gestation to 47 mm Hg at 35 weeks). The tricuspid/mitral valve annulus ratio decreased from 1.25 at 24 weeks' gestation to 0.96 at 33 weeks. At 38 weeks' gestation, a male infant weighing 3,524 g, with Apgar scores of 9 and 9 at 1 and 5 minutes, respectively, was delivered by cesarean section. Critical pulmonary stenosis was confirmed by postnatal catheterization. These findings support the postulation that pulmonary stenosis is a progressive disorder. After percutaneous balloon dilatation, the transvalvular pressure gradient decreased and the right ventricular cavity increased gradually. The transvalvular pressure gradient had decreased to 15 mm Hg and the tricuspid/mitral valve annulus ratio was 0.93 at the age of 2 years.     

Transatrial-transpulmonary repair of tetralogy of Fallot: extensive infundibular septum resection.

Twenty-seven patients with tetralogy of Fallot underwent total correction during the period from February 1988 through October 1989. Their ages ranged from 11 months to 12 years (mean 3.3 +/- 4.9 years). For 11 patients, the repair was made via the conventional transventricular approach and a partial resection of the infundibular septum. On the other 16 patients, a transatrial-transpulmonary approach was used with total resection of the anterior deviated infundibular septum, with or without a miniventriculotomy incision (1-10 mm). The exposure of the ventricular septal defect (VSD) through the right atrium, and the right ventricular outflow tract (RVOT) through the pulmonary artery in patients with tetralogy of Fallot was excellent. There were no significant differences between transatrial-transpulmonary repair and transventricular repair of the tetralogy of Fallot with respect to pulmonary artery (PA) index (273.2 +/- 36.6 versus 249.9 +/- 63.2 mm2/BSA) or the postoperative ratio of right ventricle/left ventricle (RV/LV) systolic pressure (0.55 +/- 0.16 versus 0.61 +/- 0.17). Postoperative intensive care was simple and uncomplicated, with a significantly lower catecholamine demand, less bleeding, fewer blood transfusions, and shorter stays in the cardiac Intensive Care Unit (ICU). There was no mortality in this series. This method of repair can be successfully accomplished in most patients with tetralogy of Fallot, with resultant preservation of right ventricular function (intact right ventricle).     

Ross procedure for pediatric aortic valve disease.

BACKGROUND AND PURPOSE: Currently, prosthetic selection for aortic valve replacement is still debatable in pediatric patients with aortic valve disease. Ross procedure is a time-consuming and demanding technique which may produce good results. This study assessed the results obtained with various methods of right ventricle outflow tract (RVOT) reconstruction in patients receiving Ross procedure. METHODS: From September 1996 to December 2003, 13 pediatric patients underwent Ross procedure for aortic valve disease. Their ages ranged from 1 month to 17 years (mean, 6.29 +/- 3.62 years; median, 7 years) and 2 patients were less than 1 year of age. Previous procedures in these patients included balloon dilation of the aortic valve in 10 and surgical aortic valvuloplasty in 2. RVOT was reconstructed with heterografts in 3, homografts in 3 or without extracardiac conduits in 7. RESULTS: There was 1 in-hospital death (7.7%) and 1 late death from a non-cardiac cause. One patient developed infective endocarditis with periaortic abscess 2 weeks after the Ross procedure. Eleven patients were followed for a mean of 3.3 years (range, 8 months to 8 years). There was no significant pressure gradient across the neoaorta. Severe stenosis developed gradually in 3 patients who had RVOT reconstruction with heterograft conduits. All 3 had received RVOT redo operation. None of the patients who received RVOT reconstruction without extracardiac conduits had significant pulmonary stenosis but 6 had regurgitation (nil 1, mild 3, moderate 3). No redo operation was required during follow-up (range, 8 months to 4 years). All of the 11 survivors were in New York Heart Association functional class I. CONCLUSIONS: This study found satisfactory results of Ross procedure in pediatric aortic valve disease. RVOT reconstruction without extracardiac conduit is a feasible alternative despite the availability of homograft.     

BRCA、HRD与PARP抑制剂：卵巢癌临床研究中的相关问题与思考

DNA损伤修复功能异常是肿瘤发生发展的重要特点之一［1］。乳腺癌易感基因（Breast Cancer Susceptibility Genes,BRCA）包括BRCA1和BRCA2,通过同源重组（homologous recombination,HR）整合参与DNA双链断裂的修复。BRCA1/2基因作为HR修复的关键抑癌基因,其编码的蛋白参与DNA双链损伤的修复、细胞生长和防止异常细胞分裂导致肿瘤的发生。BRCA1/2基因突变意味着抑癌基因“刹车”失控,不能有效地抑制肿瘤细胞的增殖。 浏览更多请关注本刊微信公众号及当期杂志。     

Pulmonary artery leiomyosarcoma.

Pulmonary artery leiomyosarcoma is a rare but highly lethal disease, and can be mistaken for pulmonary thromboembolism. We report a case of pulmonary artery leiomyosarcoma managed with surgical resection, chemotherapy, and radiotherapy. A 57-year-old woman was admitted with complaints of aggravated dyspnea. She was initially treated with oxygen therapy and heparinization for a suspected pulmonary embolism. Echocardiography revealed a dilated right atrium and ventricle and severe tricuspid regurgitation, with an estimated systolic right ventricular pressure of 95 mm Hg; a shadow of a mass in the main pulmonary artery was also noted. Right ventriculography revealed a filling defect, and to-and-fro motion of the mass in the main pulmonary artery. The left pulmonary artery was almost totally occluded by the mass. The patient's condition improved dramatically after palliative excision of the mass and patch reconstruction of the outflow tract of the right ventricle with a bicuspid xenograft. Pathologic examination of the mass revealed leiomyosarcoma. Chemotherapy and radiotherapy were subsequently administered and follow-up imaging studies 3 months postoperatively revealed no recurrence of the tumor. The patient remains well, more than 1 year after treatment. This report emphasises that pulmonary artery sarcoma should be considered in the differential diagnosis in cases of suspected pulmonary thromboembolism.     

Hemodynamic and clinical efficacies of catheter balloon percutaneous transvenous mitral commissurotomy: experience of 100 patients with rheumatic mitral stenosis

From January 1987 to December 1988, 100 patients with symptomatic severe rheumatic mitral stenosis underwent percutaneous transvenous mitral commissurotomy (PTMC). The patients included 32 males and 68 females, aged 19-71 years (mean of 41). Mild mitral regurgitation (grade 1 or 2) was present in 23 patients and a history of thromboembolism in 12. One patient had had mitral restenosis after surgical open mitral commissurotomy 9 years earlier. The mitral valve was successfully dilated in 97 patients. PTMC resulted in immediate improvements in hemodynamic measurements. The left atrial pressure decreased from 24.5 +/- 5.3 to 14.8 +/- 5.2 mmHg (p less than 0.001), the mean mitral transvalvular gradient from 13.8 +/- 4.8 to 5.0 +/- 2.8 mmHg (p less than 0.001), and the mean pulmonary artery pressure from 38.8 +/- 12.0 to 30.6 +/- 10.3 mmHg (p less than 0.001). The mitral valve area increased from 1.1 +/- 0.3 to 2.2 +/- 0.8 cm2 (p less than 0.001). The cardiac output increased from 4.5 +/- 1.2 to 4.84 +/- 1.2 L/min (p less than 0.05). The right atrial pressure did not change significantly after PTMC (6.5 +/- 3.8 vs 6.4 +/- 4.0 mmHg). The mitral valve area measured by 2-D echocardiograms increased from 1.04 +/- 0.48 to 1.88 +/- 0.66 cm2 after PTMC (p less than 0.001). All 97 patients were followed for 6-24 months (median of 13) after the PTMC. After an initial recovery period of 1-2 weeks, all patients reported improvements in symptoms and in New York Heart Association (NYHA) functional class by at least one class. A comparison between treadmill exercise test durations before, and 3 months after PTMC, showed an increase from 9.1 +/- 4.3 to 15.4 +/- 3.8 minutes (n = 60; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)