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經導管二尖瓣氣球擴張術治療風濕性二尖瓣狹窄

Percutaneous Transvenous Mitral Valvuloplasty(PTMV) with Inoue Balloon

摘要


1982年Kanji Inoue首創Inoue balloon擴張心臟風濕性二尖瓣狭窄(percutaneous mitral valvuloplasty,PTMV),洪瑞松教授當時由台灣長庚醫院開始,全國推廣此新技術,並到全世界各大心臟學會演講並臨床示範教學,宣揚成功經驗。洪教授早期219位心臟風濕性二尖瓣狭窄(PTMV)病患,年齡平均43歲。133位(61%)呈現心房顫動,59位(27%)同時併有1 +〜2 + Mitral regurgitation。只有在初期經驗有三位擴張失敗,完全沒有心包膜填塞或緊急開刀,只有一例因造成3+二尖瓣閉鎖不全(mitral regurgitation,MR)住院中死亡。心臟風濕性二尖瓣狹窄(PTMV)後最主要血行力學數據變化為Mean肺動脈(pulmonary artery,PA)Pressure 39.7±13.0降到30.6±0.9mmHg,MV gradient從13.0±5.0降到5.7±2.6mmHg,二尖瓣開口面積(mitral valve area,MVA)由1.0±0.3增到2.0±0.7cm^2。追踪3-4年,91%(205位)仍存活且無重大事件變化。統計文獻長期觀察心臟風濕性二尖瓣狹窄(PTMV)後10-15年,無任何重大事件變化之存活率高達40-70%,但術後造成重度二尖瓣閉鎖不全(MR)之預後較差。一般3-10年後,有10.30%病患二尖瓣膜會再狭窄,需再度進行心臟風濕性二尖瓣狹窄(PTMV)或開刀治療。過去25年風濕性二尖瓣狹窄,使用Inoue balloon進行氣球擴張是一種相當安全有效的全球性治療方式。台灣早期經驗證實,有經驗之技術熟練團隊,慎選病人作心臟風濕性二尖瓣狭窄(PTMV),低風險且能保持長短期臨床療效。

並列摘要


Percutaneous transvenous mitral valvuloplasty (PTMV)with Inoue balloon, introduced in 1982 by K. Inoue, has created a new dimension in the treatment of patients with mitral stenosis. Extensive clinical data have demonstrated this minimally invasive, non-surgical procedure to be a safe and effective therapy in patients with mitral stenosis and is equivalent to or even better than surgical commissurotomy. Wilkin echo score is important for selecting the suitable patients with a mobile, pliable, non-calcified and non-thickened valve, and for prediction of excellent acute results. Taiwan is one of the pioneer country in this field. Since 1987, Professor Hung JS has performed a lot of live demonstrations here and worldwide. Following his standard technique and strategy, many centers (including Chang Gung & Shin Kong teams) have proved PTMV to be a treatment of choice with high success (>99%) and low complication rate (<1%). In our experience with successful balloon dilatation, there is generally a twofold increased in the mitral valve are (MVA) ≥ 2cm^2 and an associated dramatic fall in MV gradient (≤ 5mmHg) and pulmonary artery pressure (less than 30%). Over the past 25 years, PTMV has shown good immediate and long-term (70% event-free survival after 10 years) clinical results, when performed by fixed, experienced teams.

並列關鍵字

PTMV Wilkin Echo Score Inoue balloon

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