经皮球囊肺动脉瓣成形术治疗婴儿重度肺动脉瓣狭窄及室间隔完整的肺动脉瓣闭锁

目的:总结经皮球囊肺动脉瓣成形术(percutaneous balloon pulmonary valvuloplasty,PBPV)治疗婴儿重度肺动脉瓣狭窄(pulmonary stenosis,PS)及室间隔完整的肺动脉瓣闭锁(pulmonary atresiawith intact ventricular septum,PA/IVS)的经验,评价其疗效及安全性。方法:自2007年1月至2012年10月,采用PBPV治疗婴儿重度PS及PA/IVS患者共33例,男性24例,女性9例,手术年龄3～12(8.9±2.9)个月,体质量5～11.5(9.0±1.6)kg。术前完善心电图、X线片、超声心动图、右心导管检查及右心室造影,采用单球囊扩张完成PBPV。PA/IVS患儿需先行肺动脉瓣射频打孔术。结果:球囊扩张手术技术成功率为96.97%(32/33)。右心室收缩压(right ventricular systolic piessure,RVSP)由术前的95～205(130.8±28.2)mmHg(1 mmHg=0.133kPa)下降至28～135(73.2±27.4)mmHg(t=12.067,P<0.001);肺动脉瓣跨瓣压差由术前的81～180(110.3±26.3)mmHg下降至10～112(47.7±23.8)mmHg(t=12.958,P<0.001)。1例术中出现心脏压塞,转外科急诊手术,术后恢复良好。出院时10例患者复查超声心动图仍显示平均跨肺动脉瓣压差>50 mmHg;随访中值时间26个月,3例残余重度肺动脉瓣狭窄,2例接受二次PBPV后压差降至轻度。本组术后发生轻度以上肺动脉瓣关闭不全(pulmonary insufficiency,PI)22例。结论:随着介入技术的不断提高,经皮肺动脉瓣球囊扩张术,已成为救治婴儿危重先天性肺动脉瓣狭窄及肺动脉瓣闭锁的安全有效的重要方法。

Percutaneous balloon pulmonary valvuloplasty treatment of infants with critical pulmonary stenosis and atresia with intact ventricular septum

Objective:To assess the effectiveness and safety of percutaneous balloon pulmonary valvoplasty(PBPV)in infants with critical pulmonary stenosis(PS) and pulmonary atresia with intact ventricular septum(PA/IVS).Methods: We reviewed 33 infants(24 males and 9 females) had critical PS or PA/IVS who underwent PBPV intervention in Pediatric Cardiology Department of Beijing Anzhen Hospital between Janaury 2007 to October 2012.Patients ranged from 3 to 12 months,with average age of(8.9±2.9)months.All patients' electrocardiogram(ECG),X-ray chest radiography and echocardiography were performed prior to the procedure.Right heart catheterization and right ventricular angiography were performed before PBPV.Patients with PA/IVS were subjected to RF valvotomy followed by PBPV under general anaesthesia.Results: PBPV were successfully achieved in 32 patients,with the probability of successful procedure of 96.9%.Post PBPV,the average right ventricular systolic pressure(RVSP) was markedly fell from 95~205(130.8±28.2)mmHg to 28~135(73.2±27.4)mmHg(P<0.001),the peak-to-peak pulmonary transvalvular gradient(PTG) was significantly dropped from 81~180(110.3±26.3)mmHg to 10~112(47.7±23.8)mmHg(P<0.001).One patient with PA/IVS appeared cardiac tamponade was switched to emergency surgery and recovered well postoperatively.10 patients had a PTG of more than 50mmHg on echocardiography before discharge.Median follow up time was 26 months(ranged from 1 to 53 months).In the 3 with moderate to severe residual pulmonary stenosis,2 received a second PBPV at 12 months follow up,all got successful results.Mild pulmonary valve insufficiency was noted in 22 patients with little apparent effect on the right ventricle.Conclusion: PBPV treatment of critical PS and PA/IVS in infants is safe and effective.