经皮球囊肺动脉瓣成形术204例临床分析

目的:探讨经皮球囊肺动脉瓣成形术(PBPV),治疗肺动脉瓣狭窄(PS)及室间隔完整的肺动脉瓣闭锁(PA/IVS)的安全性及有效性。方法:我科自1987年4月至2011年5月收治的PS 202例,PA/IVS 2例,男性116例,女性88例,年龄3个月～40岁,平均4.25岁,体质量5～60 kg,平均(17.32±8.85)kg,发绀34例。完善心电图、心脏X线像、超声心动图检查,行右心导管检查及右心室造影并完成PBPV。结果:PBPV 204例,成功200例,成功率98%。PBPV术后,导管测肺动脉瓣跨瓣压差〔(30.84±15.05)mmHg(1 mmHg=0.133 kPa)〕较术前(75.75±30.04)mmHg明显下降,P=0.001。4例失败病例中,1例因右心室流出道狭窄导丝难以到达肺动脉,取消PBPV。第2例导丝送入肺动脉出现循环不稳定取消PBPV。第3例PA/IVS,射频打孔成功后球囊扩张时出现心包填塞,转外科手术。第4例术中球囊扩张时右心室流出道撕裂致心包填塞,抢救无效死亡。其中2例出现严重并发症,1例三尖瓣腱索断裂;1例缺血、缺氧性脑病。结论:PBPV治疗PS及PA/IVS安全有效。严格掌握适应证,规范操作可以减少并发症。

Clinical analysis in 204 cases with percutaneous balloon pulmonary valvoplasty

Objective： To investigate the safety and effectiveness of percutaneous balloon pulmonary valvuloplasty（PBPV） in the treatment of pulmonary valve stenosis（PS） and pulmonary atresia with intact ventricular septum（PA / IVS）.Methods： From April 1987 to May 2011,202 patients with PS and two with PA / IVS [male 116,female 88;aged 3 months to 40 years,mean（4.25 ± 4.16） years;body weight（5-60）kg,average（17.32 ± 8.85） kg;34 cases with cyanosis] were treated in the Department of Pediatric Cardiology,Beijing AnZhen Hospital.All patients were also assessed with electrocardiogram（ECG）,X-ray chest radiography,echocardiography,right heart catheterization and right ventricular angiography before the procedure.It is important to emphasize the need to measure the pulmonary valve annulus at the hinge point.PBPV were performed in 204 patients.Results：PBPV were performed in 204,with procedural success in 200 cases（98%）.PBPV significantly reduced transvalvular pressure gradient from（75.75 ± 30.04） mmHg [（40-180）mmHg] to（30.84 ± 15.05） mmHg [（2-102）mmHg] postoperatively（P=0.001）,suggesting satisfactory results.In the 4 failed cases,the guide wire failed to reach the pulmonary artery due to right ventricular outflow tract obstruction in one patient and PBPV canceled.Case 2 had significant drop of blood pressure and heart rate and hemodynamic instability condition during the guide wire entering the pulmonary artery,and PBPV canceled.Case 3 with PA/IVS had cardiac tamponade during balloon dilatation after successful radiofrequency perforation,and were switched to emergency surgery.Case 4 had tearing of right ventricular outflow tract during balloon dilatation leading to cardiac tamponade and final death.Severe complications occurred in 2 cases,including chordal rupture of the tricuspid valve in one patient and hypoxic-ischemic encephalopathy in the other patient.We choose balloon size is determined at about 120%-140% of the pulmonary valve annulus.145 cases chose single balloon,4cases chose double balloon.In general,low inflation pressures of less than 4 atmospheres are usually sufficient to perform balloon PS.The waist of balloon disappear completely during the balloon inflation.Follow up ranges from 1 month to 12 months and it shows a good therapeutic efficacy.6 patients with critical pulmonary valve stenosis second performed PBPV and meet with success.1 patient stenosis again and underwent surgery treatment.25 patients（12%） occur mild pulmonary valve regurgitate during follow up.Conclusion： PBPV is a safe and effective method of treating PS and PA/ IVS.Strict abidance by procedural indications and standards can reduce the occurrence of complication.