| Autor: |
Ben Farhat, M., Boussadia, H., Gandjbakhch, I., Mzali, H., Chouaieb, A., Ayari, M., Ben Salah, K. |
| Zdroj: |
Journal of Thoracic and Cardiovascular Surgery; April 1990, Vol. 99 Issue: 4 p639-644, 6p |
| Abstrakt: |
Controversy persists regarding whether the efficacy of closed instrumental mitral commissurotomy compares well enough with that of open commissurotomy to warrant its continued use. The purpose of this study was to compare the results of operation as determined by catheterization studies in 63 patients with pure, severe, and noncalcified mitral stenosis. The patients were randomly assigned to one of two groups: thirty-two patients were operated on by the closed technique (group I) and 31 by the open technique (group II). All patients underwent left-sided and right-sided catheterization before and 4 months after operation. Preoperatively the two groups were statistically similar with regard to major clinical data and hemodynamic findings. There were no deaths at operation or systemic embolism in the two groups. The prevalence of surgically induced mitral regurgitation was similar in the two groups (12.4% versus 12.9%). Pulmonary arterial pressure and arteriolar and total pulmonary vascular resistance decreased significantly in the two groups. Pulmonary capillary wedge pressure decreased from 23.3 ± 8.5 to 15.8 ± 7 mm Hg in group I (p < 0.001) and from 23.7 ± 6 to 14 ± 5.8 mm Hg in group II (p < 0.001). Cardiac index increased from 2.86 ± 0.84 to 3.14 ± 0.78 L/min/m2in group I, but this increase did not reach statistical significance. In group II cardiac index increased from 2.89 ± 0.6 to 3.6 ± 0.6 L/min/m2(p < 0.005). The mean and end-diastolic transmitral pressure gradients decreased significantly in the two groups, but the decrease was statistically greater in the open mitral commissurotomy group (p < 0.001). Mitral valve area increased from 0.82 ± 0.18 to 1.4 ± 0.40 cm2in group I (p < 0.01) and from 0.84 ± 0.15 to 2.14 ± 0.53 cm2in group II (p < 0.001). The mean increase in mitral valve area was 0.61 cm2in group I and 1.34 cm2in group II (p < 0.001). At exercise, in patients with resting pulmonary capillary wedge pressures of 18 mm Hg or less, cardiac index increased by 36% in group I (23 patients) and 48% in group II (24 patients), because of a smaller mitral valve area in group I (1.61 ± 0.39 cm2) than in group II (2.45 ± 0.65 cm2). Thus open commissurotomy improved hemodynamic values to a greater extent than closed commissurotomy at both rest and exercise. The results of this study support the view that open commissurotomy should be preferred even in highly selected patients with pure, severe, noncalcific mitral stenosis. |
| Databáze: |
Supplemental Index |
| Externí odkaz: |
|
