승모판 협착증에서 치료 방법에 따른 임상 및 심초음파 소견의 변화
Clinical and echocardiographic changes in patients with mitral stenosis according to different therapeutic modalities
소속 상세정보
조인종/In Jong Cho
김 원/김계훈/강경태/안영근/정명호/조정관/박종춘/강정채/안병희/김상형/Weon Kim/Kye Hun Kim/Kyung Tae Kang/Young Keun An/Myung Ho Jeong/Jung Kwan Cho/Jong Chun Park/Jeong Chae Kang/Byoung Hee Ahn/Sang Hyung Kim
KMID : 0882420010600060537
Abstract
중등도 이상의 승모판 협착증의 경우 약물 치료군에 비해 경피적 승모판 확장술 및 인공 승모판막 치환술 군에서 좋은 임상경과 및 승모판 개구면적 유지를 보여 단순한 약물 치료보다는 좀 더 적극적인 치료가 요망된다. 약 5 년간의 추적관찰기간 동안 좌심실의
내경 및
좌심실 구혈율 등 좌심실 기능은 각 군에서 유의한 변화가 없었다.
또한 장기추적 조사결과 약물 치료나 풍선도자 확장술, 승모판막 치환술 모두에서 추적관찰동안 동반된 경한 대동맥판(47.9 %), 승모판막(51.1 %), 삼첨판막(66.0 %) 폐쇄부전증들의 임상적으로 심각한 악화는 발견 할 수 없었다. 그러므로 경도의 판막 폐쇄부전증
들이
동반되는 경우는 승모판 협착증의 치료 방침 결정 시 이들에 대한 조기 치료를 할 필요는 없을 것으로 생각된다.
Background : Although rheumatic mitral stenosis is still a prevalent and clinically significant valvular heart disease in Korea, the natural history of rheumatic mitral stenosis has not been clearly determined yet. The present study aimed to
evaluate
the clinical and echocardiographic changes in patients with rheumatic mitral stenosis according to different therapeutic modalities.
Methods : A total of 91 patients (66 women; mean age, 50.9±12 years) with dominant rheumatic mitral stenosis and mitral valve area of less than 1.5 cm2 who were followed for more than 3 years (mean: 5.1 years) were included in this study. The
subjects
were divided into 3 groups according to the therapeutic modalities for mitral stenosis (A: medical therapy (n=31), B: percutaneous mitral valvuloplasty (n=30), C: mitral valve replacement (n=30)). Clinical and echocardiographic follow-up was
performed
before and immediately after therapeutic intervention such as percutaneous mitral valvuloplasty (PMV) and mitral valve replacement (MVR) and every year thereafter. Clinical symptoms and echocardiographic findings were compared between 3 groups.
Results : The patients of group B consisted of less females and more younger (p=NS). Clinical symptom of dyspnea was more severe in group B and C initially (A: 1.8±0.8, B: 2.5±0.8, C: 2.9±0.7; A vs. B, A vs. C, p<0.05) but more improved in
group
B
and C (A: 1.6±0.5, B: 1.3±1.0, C: 1.6±0.5; A vs B, A vs. C, p<0.05) during the follow-up. The prevalence of atrial fibrillation did not change significantly during follow-up. Mitral valve area decreased significantly in A group from 1.1±0.4
to
0.9±0.3 cm2 (p<0.05), but, no significant change was observed in group B and C. No significant changes were observed in the left ventricular end-diastolic, end-systolic dimensions, and ejection fraction during the follow-up period. No clinically
significant aggravations of associated valvular
regurgitations and systolic pulmonary artery pressure were observed.
Conclusion : In patients with mitral stenosis more than moderate severity, PMV or MVR is superior to medical therapy for controlling clinical symptoms and maintaining the mitral valve area. Therapeutic modality does not influence the change in
the
dimension and systolic function of the left ventricle. Accompanied other valvular regurgitation does not change significantly regardless of therapeutic modality, indicating that any additional therapy for associated valvular regurgitation is
unnecessary.
키워드
Balloon dilatation; Echocardiography; Mitral valve stenosis;
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