~Teachingcenter的醫學筆記~

經皮穿靜脈氣球導管二尖瓣成形術(Percutaneous transvenous mitral valvuloplasty, PTMV)自1982年被提出後，至今已經是二尖瓣狹窄(Mitral stenosis)的主要治療方式，然而並不是每一個病人都可以獲益於這個治療，因此有許多可以參考的術前評分指標

 

其中一項就是威爾金斯(超音波)分數Wilkins (Echocardiographic) Score
= 同意的也有人稱為Abascal Score或Boston Score

 

Wilkins Score中有四個評分項目，每個項目最低一分，最高四分，所以總分最低四分，最高十六分

= Leaflet Mobility
-- 1分：Highly mobile valve with restriction of only the leaflet tips
-- 2分：Mid portion and base of leaflets have reduced mobility
-- 3分：Valve leaflets move forward in diastole mainly at the base
-- 4分：No, or minimal, forward movement of the leaflets in diastole

= Valvular Thickening
-- 1分：Leaflets near normal (4-5 mm)
-- 2分：Mid leaflet and margin thickening
-- 3分：Thickening extends through the entire leaflets (5-8 mm)
-- 4分：Pronounced thickening of all leaflet tissue (>8-10 mm)

= Subvalvuar Thickening
-- 1分：Minimal thickening of chordae just below the valve
-- 2分：Thickening of chordae up to one third of chord length
-- 3分：Thickening extending to the distal third of the chordae
-- 4分：Extensive thickening and shortening of all chordae down to the papillary muscle

= Valvuar Calcification
-- 1分：Single area
-- 2分：Scattered areas confined to leaflet margins
-- 3分：Extending into the mid portion of leaflets
-- 4分：Extensive; Through most of the leaflet tissue

總分小於8分，對於經皮穿靜脈氣球導管二尖瓣成形術(PTMV)有較好的預後

 

※ Wilkins Score只是其中一項參考，其他的評估指標還包括commissural calcification or fusion、mixed mitral valve disease ((Rheumatic disease) pre-procedure mitral regurgitation >2、post-procedure mitral regurgitation >3)、age、prior surgical commissurotomy、NYHA functional class IV以及higher post-procedure pulmonary artery pressure。由以上的結果來評估此病人的二尖瓣狹窄，是導管手術比較好，還是開胸手術比較好。

 

 

Wilkins GT, Weyman AE, Abascal VM, et al. Percutaneous balloon dilatation of the mitral valve: an analysis of echocardiographic variables related to outcome and the mechanism of dilatation. British Heart Journal 1988, 60 (4): 299-308