肺动脉瓣狭窄行经皮肺动脉瓣球囊扩张治疗52例近期随访分析

目的：探讨经皮肺动脉瓣球囊扩张术（PBPV）治疗肺动脉瓣狭窄（PS）的安全性和有效性。方法选取武汉亚洲心脏病医院先心病中心2007年至2012年收治的单纯PS患者52例，其中男24例，女28例，年龄1～56（9.2±7.6）岁，体重10～60（17.3±8.9）kg。完善心电图、X线胸片、超声心动图检查，行右心导管检查及右心室造影并完成PBPV术。结果所有患者均手术成功。PBPV术后，导管测右心室肺动脉瓣跨瓣压差（13.8±7.7）mmHg（1 mmHg=0.133 kPa）较术前（86.3±27.6）mmHg显著下降，差异有统计学意义（P＜0.01）。术中，1例（1.9%）出现心室颤动而发生阿斯综合征，1例（1.9%）突发呼吸、心跳骤停，24例（46.2%）出现一过性心律失常，1例（1.9%）低血压，1例（1.9%）心动过缓，1例（1.9%）氧饱和度下降，给予相应处理均好转；2例（3.8%）出现穿刺后血肿，2例（3.8%）术后反应性漏斗部狭窄。结论 PBPV术在肺动脉瓣狭窄患者中应用安全，效果好，并发症少，患者痛苦小，应作为该类患者的首选治疗方法。

Clinical analysis of percutaneous balloon pulmonary valvuloplasty in the treatment of 52 patients with pulmonary stenosis

Objective To investigate the safety and effectiveness of percutaneous balloon pulmonary valvuloplasty （PBPV） in the treatment of pulmonary stenosis （PS）. Methods The subjects were 52 patients with PS from 2007 to 2012, including 24 male and 28 female. Their age ranged from 1 year old to 56 year old and mean age was 9.2±7.6 years old. Their body weight ranged from 10 kg to 60 kg and mean weight was 17.3±8.9 kg. All patients were assessed with electrocardiogram （ECG）, chest X-ray, right heart catheterization and right ventricular angiagraphy before the procedure. Results All 52 patients received PBPV successfully. Comparing the transvalvular pressure gradient before and after the operation, it decreased from 86.3±27.6 mmHg （1 mmHg=0.133 kPa） to13.8±7.7 mmHg, and statistically difference （P〈0.01）. Among these patients, one patient occurred ventricular fibrillation and Aspen syndrome （hypoxie-ischemic encephalopathy）, one patient occurred respiratory and cardiac arrest, 24 patients occurred transient arrhythmia, one patient had hypotension, one patient had bradycardia and one patient showed desaturation. All these symptoms resolved after appropriate treatment during the PBPV. Two patients had hematoma in the puncture point and 2 patients had reactive infundibular stenosis after PBPV. Conclusions Performing the percutaneous balloon pulmonary valvoplasty on the patients with pulmonary stenosis is safe and effective. PBPV causes less pain and can be used as the preferred treatment for pulmonary stenosis.