중등도 및 중증 승모판 협착증 환자에서 경피적 승모판 성형술의 장기 성적 비교

Abstract

Background and Objectives: Percutaneous mitral balloon valvuloplotomy (PMV) is a safe and effective procedure for the treatment of mitral stenosis (MS); however, its long-term results according to the severity of MS remain unknown. The aim of this study was to compare the long-term results of PMV between moderate and severe MS.

Subjects and Methods: The immediate and long-term outcomes of 786 patients (198 male, mean age; 43 years) who underwent PMV at a single referral center, between 1988 and 2000, were analyzed. The clinical and echocardiographic data were compared between moderate (n=357) and severe MS (n=429).

Results: Optimal results were gained in 618 (79%) patients, including 80 and 76% moderate and severe MS cases, respectively (p=0.13). Acute complications occurred in 85 patients (11%), but without significant difference between the two groups. After a mean follow-up period of 94 months (range, 6 to 210 month), the 5 year event-free survival rate was better in moderate (88%) than in severe MS (79%), but the 10 year event-free survival rates were no different (65% vs. 65%). Independent predictors for better prognosis were a lower echo score (≤8)(p=0.017, HR=0.67), a larger mitral valve area after the PMV (≥1.7 cm2)(p=0.002, HR=0.65), less mitral regurgitation (III) (p=0.001, HR=0.46) and a lower left atrial pressure (<12 mmHg)(p=0.005, HR=0.80).

Conclusion: The immediate and long-term outcomes of PMV for moderate MS were no better after 9 years than those for severe MS. Therefore, PMV for moderate MS should be considered in selected cases with a favorable MV morphology.