수술적 교련절개술후 재협착이 온 환자에서 경피적 승모판 풍선 성형술의 장기 추적 결과

Abstract

Background Precutaneous mitral balloon valvuloplasty(PMV) is known to produce shortterm hemodynamic and symptomatic improvement in selected patients with restenosis after previous surgical commissurotomy.

Methods To evaluated the long-term efficacy of PMV and identify the risk factors for restenosis after this procedure in patients with mitral restenosis after previous surgical commissurotomy, we obtained 30.4±13.0 months(range, 6-53) follow-up data in 19 patients with restenosis after previous surgical commissurotomy on whom PMV was successfully performed since April, 1988.

Results There were 10 females and 9 males with mean age of 42.7±8.7(range, 28-59). 11 patients were in atrial fibrillation. Restenosis occurred in 8 patients(42%) during follow-up. Median value for restenosis by Kaplan-Meier survival analysis was 40 months. Restenosis by univariate analysis correlated with smaller valve area after PMV and short interval from previous surgical commissurotomy to restenosis. Mitral valve area after PMV and echoscore were found to be the determinant predictors of restenosis by Cox proportional hazard analysis. For mitral valve area after PMV, patients with post-PMV valve area less than 1.6cm2have relatively high risk for restenosis than those with post-PMV valve area more than 1.6cm2.

Conclusion Half of the patients who underwent PMV due to restenosis after previous surgical commissurotomy maintained optimal result up to 40 months. Poorer long-term outcome can be predicted in patients with unfavorable valve morphology or post-PMV valve area less than 1.6cm2.