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首页> 外文期刊>The American Journal of Cardiology >Effectiveness and safety of percutaneous coronary sinus-based mitral valve repair in patients with dilated cardiomyopathy (from the AMADEUS trial).
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Effectiveness and safety of percutaneous coronary sinus-based mitral valve repair in patients with dilated cardiomyopathy (from the AMADEUS trial).

机译：扩张型心肌病患者经皮冠状动脉窦二尖瓣修复的有效性和安全性（来自AMADEUS试验）。

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摘要

This report presents the procedural results from the AMADEUS trial that support coronary sinus (CS)-based percutaneous mitral annuloplasty. Despite therapeutic advances, functional mitral regurgitation (MR) continues to be a significant clinical problem for patients with dilated cardiomyopathy. CS approaches to mitral valve repair have been viewed with skepticism because of the distance of the CS/great cardiac vein from the mitral valve annulus and the potential to compress a coronary artery. This report presents the procedural results from the AMADEUS trial that support CS-based percutaneous mitral annuloplasty. Patients who met the inclusion criteria were eligible to receive a mitral annuloplasty device. Transesophageal echocardiography was used to assess changes in MR, angiography was used to assess the coronary arteries, and multislice computed tomography was used to evaluate the anatomic relations between the coronary venous system and the mitral valve. Acute MR reduction (grade 3.0 +/- 0.6 to 2.0 +/- 0.8, p <0.0001) and permanent implantation were achieved in 30 of 43 patients in whom an attempt was made. Additional measurements in 20 patients with implants showed reductions in the vena contracta (0.69 +/- 0.29 to 0.46 +/- 0.26 cm, p <0.0001), effective regurgitant orifice area (0.33 +/- 0.17 to 0.19 +/- 0.08 cm(2), p <0.0001), regurgitant volume (40 +/- 20 to 24 +/- 11 ml, p = 0.0005), and jet area/left atrial area (45 +/- 13% to 32 +/- 12%, p <0.0001). The coronary arteries were crossed in 36 patients (84%). Arterial compromise contributed to a lack of implantation in 6 patients (14%). No difference was found in the CS/great cardiac vein position relative to the annulus between the patients who did and did not have a reduction in MR. In conclusion, percutaneous mitral annuloplasty reduces MR and permanent implantation can be achieved in most eligible patients.
机译：本报告介绍了支持基于冠状窦（CS）的经皮二尖瓣瓣环成形术的AMADEUS试验的程序结果。尽管有治疗上的进步，功能性二尖瓣关闭不全（MR）仍然是扩张型心肌病患者的重要临床问题。由于CS /大心脏静脉与二尖瓣环之间的距离以及压迫冠状动脉的可能性，人们对CS二尖瓣修复的方法持怀疑态度。本报告介绍了AMADEUS试验的程序结果，该结果支持基于CS的经皮二尖瓣瓣环成形术。符合纳入标准的患者有资格接受二尖瓣瓣环成形术设备。经食道超声心动图用于评估MR的变化，血管造影用于评估冠状动脉，多层计算机断层扫描用于评估冠状静脉系统与二尖瓣之间的解剖关系。尝试进行的43例患者中有30例达到了急性MR降低（3.0 +/- 0.6至2.0 +/- 0.8，p <0.0001）。在20例植入物患者中进行的其他测量显示，腔静脉收缩减少（0.69 +/- 0.29至0.46 +/- 0.26 cm，p <0.0001），有效的反流口面积（0.33 +/- 0.17至0.19 +/- 0.08 cm（ 2），p <0.0001），返流容积（40 +/- 20至24 +/- 11 ml，p = 0.0005）和射流面积/左心房面积（45 +/- 13％至32 +/- 12％ ，p <0.0001）。 36名患者（84％）的冠状动脉交叉。动脉损伤导致6例患者（14％）缺乏植入。相对于环空的CS /大心脏静脉位置在没有和没有MR降低的患者之间没有发现差异。总之，经皮二尖瓣瓣环成形术可降低MR，在大多数合格患者中可以实现永久植入。

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