Immediate and Long-Term Outcome of Redo Percutaneous Mitral Valvuloplasty: Comparison with Initial Procedure in Patients with Rheumatic Mitral Restenosis

Aims: We explored the immediate and long-term outcome of redo percutaneous mitral valvuloplasty (PMV) in a series of patients with mitral restenosis in comparison with initial PMV in the same series.
Methods: We enrolled 40 consecutive patients presenting with mitral restenosis after successful initial PMV. Redo PMV was performed by the antegrade transseptal approach using either the Inoue technique or the multitrack technique. Reassessment by transthoracic echocardiography was repeated 48 hours later, and annually thereafter. Procedural success was defined as 50% or more increase of mitral valve area (MVA) with a final MVA ≥1.5 cm², without major complications. Restenosis was defined as loss of >50% of the initial gain of MVA by the preceding PMV with a final MVA <1.5 cm².
Results: Procedural success was achieved in 37 (92.5%) patients. Both the initial and redo procedures were similar concerning the final MVA and mean transmitral pressure gradient (P > 0.05 for all). The gain of MVA was higher in the initial as compared to the redo procedure (P < 0.001). The initial mitral valve score correlated negatively with the final MVA in both the initial and redo procedures, and was the only independent predictor of the time to redo procedure, by multivariate regression analysis. At long-term follow-up (61 ± 2.8 months), the mean MVA was 1.6 ± 0.3 cm². Three patients—out of 12 available for follow-up—developed restenosis.
Conclusion: Redo PMV for mitral restenosis is feasible, safe, and achieves immediate and long-term outcome comparable to initial PMV. (J Interven Cardiol 2010;23:1–6)     

风湿性心脏病二尖瓣球囊扩张术前后氧自由基变化的观察

心脏缺血和再灌注过程中，氧自由基的生成、代谢和消除是影响心肌损伤严重程度的重要因素。本文对２０例风心病二尖瓣窄狭患者经皮穿刺球囊成形术后较术前的氧自由基的代谢产物丙二醛（ＭＤＡ）明显增高（Ｐ＜０．０５）以及内源性氧自由基清除剂超氧化物歧化酶（ＳＯＤ）、谷胱甘肽过氧化物酶（ＧＳＨ─Ｐｘ）下降，但无显著差异（Ｐ＞０．０５），仍基本符合缺血／再灌注损伤规律。     

经皮球囊二尖瓣扩张术的并发症及其处理

采用Inoue球囊法进行经皮球囊二尖瓣成形术治疗风湿性二尖瓣狭窄病人共300例，术后左房平均压由3．26±1．14kPa（1kPa＝7．5mmHg）降至1．33±0．89kPa，跨瓣压差由2．41±0．93kPa降至0．44±0．39kPa，二尖瓣口面积由1．03±0．23cm2增至2．09±0．38cm2；无一例死亡，53例出现不同的并发症，包括急性心包填塞5例（1．7％），二尖瓣反流（≥2级）9例（3％），肢体动脉栓塞1例（0．3％），房间隔水平分流14例（4．7％），并发症中仅6例因病情严重而需外科手术处理。本文对各种并发症的发生，预防和应急处理措施进行了讨论。     

Immediate and Long‐term Results Following Balloon Mitral Valvotomy in Patients With Atrial Fibrillation

Background:

The purpose of this study was to examine the influence of atrial fibrillation (AF) on the immediate and long‐term outcome of patients undergoing balloon mitral valvotomy (BMV).

Hypothesis:

Patients with atrial fibrillation fair poorly after balloon mitral valvotomy.

Methods:

There were a total of 818 consecutive patients who underwent elective BMV in this institute from 1997 to 2003, with either double‐lumen or triple‐lumen BMV catheters included in the study. Of them, 95 were with AF. The clinical, echocardiographic, and hemodynamic data of these patients were compared with those of 723 patients in normal sinus rhythm (NSR). Immediate procedural results and long‐term events were compared between the 2 study groups.

Results:

Patients with AF were older (39.9 ± 9.9 years vs 29.4 ± 10.1, P < 0.001) and presented more frequently with New York Heart Association (NYHA) class III‐IV (53.7% vs 32.9%, P < 0.001), echocardiographic score >8 (47.4% vs 24.9%, P < 0.001), and with history of previous surgical commissurotomy (33.7% vs 11.5%, P < 0.001). In patients with AF, BMV resulted in inferior immediate and long‐term outcomes, as reflected in a lesser post‐BMV mitral valve area (1.3 ± 0.4 vs 1.6 ± 0.4 cm 2. , P = 0.032) and higher event rate on follow‐up.

Conclusions:

Patients with AF were older, sicker, and had advanced rheumatic mitral valve disease. They had a higher incidence of stroke, new onset heart failure, and need for reinterventions on long‐term follow‐up. These patients need intense and more frequent follow‐up. Clin. Cardiol. 2011 DOI: 10.1002/clc.22068 The authors have no funding, financial relationships, or conflicts of interest to disclose.     

先天性二尖瓣关闭不全患儿成形手术近中期结果分析

目的:总结先天性二尖瓣关闭不全患儿成形手术治疗的近中期结果。方法:选择自2016年1月至2018年1月因中重度二尖瓣关闭不全于我院行“三步法”二尖瓣成形术治疗的患儿70例。研究分析患者二尖瓣病变特征,术中操作要点,手术安全性和有效性,术后并发症及近中期随访结果。结果:70例患儿中男性31例,女性39例;年龄中位数23.83(四分位间距7.58,52.39)个月;身高85.50(67.75,105.25)cm;体重11.75(6.48,16.88)kg。手术均采用胸骨正中切口,均在全麻低温体外循环下进行。体外循环时间(102.10±40.65)min,主动脉阻断时间(67.76±32.97)min。术后住院15.50(11.75,25.75)天,术后早期死亡率为2.86%。术后二尖瓣中度以上关闭不全患者比例较术前显著降低(术前100%,术后7.14%;P<0.01)。术后随访20(17.45~26.30)个月。随访期间死亡率为1.5%,再次手术发生率为7.35%,二尖瓣中量以上反流发生率为14.71%。结论:“三步法”二尖瓣成形术是一种安全、有效的治疗方法,近中期结果良好,为二尖瓣关闭不全患儿提供了一种可靠的手术选择。     

经皮球囊二尖瓣成形术治疗前后血流动力学和心功能的对比研究

本文观察了75例风湿性二尖瓣狭窄(MS)患者经皮球囊导管二尖瓣成形术(PBMV)治疗前、后的血流动力学和心功能的变化.结果显示、术后即刻二尖瓣压力阶差,肺动脉和左房平均压下降.左房内径缩小,而二尖瓣口面积增大.心输出量和射血分数等各项心功能指标显著增加,表明PBMV是一项非开胸治疗MS的有效方法.     

Short‐Term Intensive Family Therapy for Adolescent Eating Disorders: 30‐Month Outcome

Family therapy approaches have generated impressive empirical evidence in the treatment of adolescent eating disorders (EDs). However, the paucity of specialist treatment providers limits treatment uptake; therefore, our group developed the intensive family therapy (IFT)—a 5‐day treatment based on the principles of family‐based therapy for EDs. We retrospectively examined the long‐term efficacy of IFT in both single‐family (S‐IFT) and multi‐family (M‐IFT) settings evaluating 74 eating disordered adolescents who underwent IFT at the University of California, San Diego, between 2006 and 2013. Full remission was defined as normal weight (≥95% of expected for sex, age, and height), Eating Disorder Examination Questionnaire (EDE‐Q) global score within 1 SD of norms, and absence of binge–purging behaviours. Partial remission was defined as weight ≥85% of expected or ≥95% but with elevated EDE‐Q global score and presence of binge–purging symptoms (<1/week). Over a mean follow‐up period of 30 months, 87.8% of participants achieved either full (60.8%) or partial remission (27%), while 12.2% reported a poor outcome, with both S‐IFT and M‐IFT showing comparable outcomes. Short‐term, intensive treatments may be cost‐effective and clinically useful where access to regular specialist treatment is limited. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.     

OCDS Craving Scores Predict 24‐Month Outcome in Alcoholic Outpatients

This study was conducted to replicate previous findings on the predictive value of a German version of the Obsessive Compulsive Drinking Scale (OCDS) by investigating 24‐month treatment outcome in an outpatient setting. This was a prospective, observational study with 92 alcohol‐dependent patients. The OCDS was used to assess craving at the end of treatment, and at the 6‐, 12‐, and 24‐month follow‐ups. Univariate and logistic regression analyses were performed. Of the 67 patients interviewed at the 24‐month follow‐up, 58% were abstinent and 79% improved. OCDS scores were higher in patients with a less favorable outcome. In line with previous findings, our results showed that the intensity of craving as measured by the OCDS may predict outcome in outpatient alcoholics. (Am J Addict 2010;19:264–269)     

利用多普勒超声对二尖瓣球囊扩张术后肺动脉高压预后的随访评价

目的评价经皮二尖瓣球囊扩张术(PBMV)对二尖瓣狭窄合并肺动脉高压患者的近、中、远期疗效.方法对26例术前、术后、随访中均存在经超声证实的三尖瓣反流,同时合并肺动脉高压的二尖瓣狭窄患者,利用多普勒超声估测其肺动脉收缩压(PASP)值,并进行随访评价,随访时间1～10.6(平均3.5±1.5)年.结果26例患者PASP估测值由术前的65.66±19.50mmHg(1mmHg=0.133kPa)降至术后即时的43.85±11.97mmHg,近、中、远期随访估测值分别为41.81±8.26mmHg、41.77±9.30mmHg和44.04±10.05mmHg,均较术前有显著下降,有非常显著性差异(P＜0.01),较术后即时值无明显差异(P＞0.05),但远期随访估测值较中期有显著意义的升高(P＜0.01).结论PBMV对二尖瓣狭窄合并肺动脉高压患者有较好的近、中期疗效,其远期疗效尚不确定,还有待进一步研究.     

Disappearance of Spontaneous Echographic Contrast after Balloon Mitral Valvuloplasty: An Indicator of Sustained Hemodynamic Improvement

In three patients undergoing mitral balloon valvuloplasty for mitral stenosis transesophageal echocardiography was performed before, immediately after, and 6 months after the procedure. In the one patient with persistent hemodynamically favorable result, the spontaneous echocardiographic contrast, which was seen in all three preoperatively, did not recur; in the other two patients the phenomenon was observed again after 6 months. We conclude that the disappearance of spontaneous echocardiographic contrast might be a functional morphological measure of sustained hemodynamic improvement after balloon mitral valvuloplasty.     

Immediate and Follow‐Up Results of Repeat Percutaneous Mitral Balloon Commissurotomy for Restenosis After a Succesful First Procedure

Background: The widespread use of percutaneous mitral commissurotomy (PMC) has led to an increase in restenosis cases. The data regarding follow‐up results of repeat PMC are quite limited. The aim of this retrospective analysis is to evaluate the immediate and midterm results of the second PMC, in patients with symptomatic mitral restenosis after a succesful first procedure. Methods: Twenty patients (95% female, mean age 37 ± 4 years) who have undergone a second PMC, 6.3 ± 2.5 years after a first successful intervention built the study group. All were in sinus rhythm, with a mean Wilkins score of 8.5 ± 1.2. Results: The valve area increased from 1.2 ± 0.2 to 1.9 ± 0.2 cm² and mean gradient decreased from 10.5 ± 3.4 to 6.1 ± 1.1 mmHg. There were no complications except for a transient embolic event without sequela (5%) and two cases (10%) of severe mitral regurgitation. The immediate success rate was 90%. The mean follow‐up was 70 ± 29 months (36–156 months). The 5‐year restenosis and intervention (repeat PMC or valve replacement) rates were 9.1 ± 5.2% and 3.6 ± 3.3%, respectively. The intervention free 5‐year survival in good functional capacity (New York Heart Association [NYHA] I–II) was 95.1 ± 5.5% and restenosis and intervention free 5‐year survival with good functional capacity was 89.7 ± 6.8%. Conclusions: Although from a limited number of selected patients, these findings indicate that repeat PMC is a safe and effective method, with follow‐up results similar to a first intervention and should be considered as the first therapeutic option in suitable patients. (Echocardiography 2010;27:765‐769)     

二尖瓣狭窄球囊成形术后心房颤动的复律治疗及其影响因素

为评价二尖瓣球囊成形术（ＰＢＭＶ）后心房颤动的复律疗效及维持窦性心律的影响因素，对３０例风湿性心脏病二尖瓣狭窄伴心房颤动（简称二狭房颤）的患者在ＰＢＭＶ后１～２周进行复律治疗。结果显示：ＰＢＭＶ后近期复律治疗房颤均能转复为窦性心律。随访１９～４６（３１．６±７．１）月，２２例患者仍维持窦性心律（７３．３％）。房颤复发与患者的年龄、二狭程度无明显关系。房颤病程超过１２个月，ＰＢＭＶ后左房残留压较高和术后左房回缩程度小是房颤复发的重要影响因素。