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

1982年Kanji Inoue首創Inoue balloon擴張心臟風濕性二尖瓣狹窄（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狹窄（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（pulmonaryartery, PA）Pressure 39.7士13.0降到30.6士0.9mmHg，MV gradient從13.0士5.0降到5.7士2.6mmHg，二尖瓣開口面積（mitral valve area, MVA）由1.0士0.3增到2.0士0.7cm2。追蹤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％病患二尖瓣膜會再狹窄，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狹窄（PTMV），低風險且能保持長短期臨床療效。 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) 2cm2 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.