经皮球囊肺动脉瓣扩张术（附二例报告）

采用经皮球囊肺动脉瓣扩张术（ＰＢＰＶ）治疗先天性肺动脉瓣狭窄２例。均为男性、年龄分别为４．５岁、６．５岁。采用快速换片代替电影摄像测定瓣环直径。所用球囊直径大于瓣环直径的１５％和３３％；扩张前跨瓣压差分别为８．９３ｋＰａ（６７ｍｍＨｇ），３．０６ｋＰａ（２３ｍｍＨｇ）；扩张后分别降至１．３３ｋＰａ（１０ｍｍＨｇ），（０．２７ｋＰａ（２ｍｍＨｇ），即刻效果显著，随访三至五个月效果维持即刻水平。此方法操作简便、安全、经济、有效，可做为肺动脉瓣狭窄开胸手术的替代疗法。若无电影摄像，可用快速换片代替。     

113例经皮球囊肺动脉瓣成形术的进一步分析

回顾１１３例经皮球囊肺动脉溶成形术（ＰＢＰＶ）的经验。患者年龄２～４５（平均１３．３）岁。术后即刻肺动脉－右室平均收缩压差自１２．２±５．２ｋＰａ（９１．７±３８．８ｍｍＨｇ）下降到４．５±３．９ｋＰａ（３３．４±２９．６ｍｍＨｇ），平均跨瓣压差下降到１．８±１．１ｋＰａ（１３．２±８．５ｍｍＨｇ）。３～３４（平均１８．４）个月后１８例复查右心导管，证实了ＰＢＰＶ中期疗效的可靠性。作者比较了使用单球囊，双球囊和Ｉｎｏｕｅ球囊行ＰＢＰＶ的结果，指出后者疗效更佳，推荐用于少年和成人组患者。本文还讨论了ＰＢＰＶ并发症、心肌激惹所致右室流出道压差的测量和转归等问题。     

瓣膜球囊扩张术治疗右向左分流重症肺动脉瓣狭窄

报告１０例伴有右向左分流重症肺动脉瓣狭窄，应用超大球囊法进行经皮球囊肺动脉瓣扩张术，肺动脉瓣扩张术跨瓣压差（△Ｐ）由术前１５．８±５．９ｋＰａ降至２．６±０．５ｋＰａ，术时动脉血氧饱和度（ＳａＯ２）由术前８６．８±３．７％降至６１．８±２６．１％，术毕时ＳａＯ２升至９３．４±４．１％。随访６个月内７例ＳａＯ２达≥９０％，２例于６～１２个月ＳａＯ２达≥９５％，１例ＰＢＰＶ后３年ＳａＯ２仍为９２％。作者认为重症肺动脉瓣狭窄伴右向左分流仍为ＰＢＰＶ适应证，并着重讨论球囊扩张术方法。     

Inoue气囊经皮瓣膜成形术治疗成人肺动脉瓣狭窄

１９８５年１２月至１９９４年８月，５３例成人先天性肺动脉瓣狭窄（ＰＳ）患者用Ｉｎｏｕｅ气囊进行经皮肺动脉瓣成形术（ＰＢＰＶ），成功率为１００％，无严重并发症。术后ＰＶＤ口压力阶差从９０．９±４５．９ｍｍＨｇ减至３８．１±３２．３ｍｍＨｇ（Ｐ＜０．００１）。ＰＶ口直径从８．９±３．６ｍｍ增至１７．４±４．６ｍｍ（Ｐ＜０．００１）。在６．４±２．８（０．８至９．５）年的随访期，心功能保持在Ⅰ级至Ⅱ级，其中９例重行心导管术检查，术前术后及随访的ＰＶ压力阶差分别为１０６．９±４７．７ｍｍＨｇ、５０．１±２９．２ｍｍＨｇ及２９．６±１６．０ｍｍＨｇ（术前比术后及随访Ｐ＜０．０５）；ＰＶ口径分别为８．２６±１．４、１７．２±２．０５及１８．７±１．３ｍｍ（Ｐ＜０．００１）（术前比术后及随访Ｐ＜０．０５）．认为Ｉｎｏｕｅ气羹ＰＢＰＶ对ＰＳ是有效和安全的方法，远期疗效满意。     

小儿经皮双叶球囊肺动脉瓣成形术30例报告

本文报道３０例先天性肺动脉瓣狭窄患儿经皮双叶球囊瓣膜成形术，采用球囊／瓣环比为，１．５－１．６，术后即刻效果良好，ＲＶ及Ｐ由述前１１．５０±５．７５ＫＰａ及８．３３±５．４ＫＰａ降到５．６１±４．７７ｋＰａ及１．５３±０．８７ｋＰａ（Ｐ＜０．０１），无严重并发症，２０例患儿经１—１２个月随诊疗效确切，我们体会双叶球囊方便，安全，有效，经济，对３岁以上肺动脉瓣狭窄患儿可作为首选方法。     

氨氯地平对高血压病人胰岛素敏感性的影响

为探讨氨氯地平对高血压病人胰岛素敏感性的干预作用。我们测定２２例高血压病人，２２例正常血压者胰岛素敏感性以及高血压病患者氨氯地平治疗后（剂量５～１０ｍｌ／ｄ，疗程４周）的胰岛素敏感性变化。以正常血糖胰岛素钳夹技术测定葡萄糖代谢率作为胰岛素敏感性指标。结果发现：（１）高血压病人氨氯地平治疗后血压比治疗前有显著降低［收缩压：１７．４±１．５ｋＰａ（１３１±１１．３ｍｍＨｇ）比２１．３±２；３ｋＰａ（１６０±１７．５ｍｍＨｇ），Ｐ＜０．０１；舒张压：１０．３±１．０ｋＰａ（７７±７．５ｍｍＨｇ）比１２．５±１．６ｋＰａ（９４±１１．７ｍｍＨｇ），Ｐ＜０．０１］，总有效率达９０；９％；（２）合并胰岛素敏感性降低的高血压病人治疗后葡萄糖代谢率明显增高（４．８４±０．６７ｍｇｋｇ－１／ｍｉｎ比６．３５±１．２８ｍｇｋｇ－１／ｍｉｎ，Ｐ＜０．０１），而胰岛素敏感性正常的高血压病人治疗后葡萄糖代谢率无明显变化（８．３５±１．０５ｍｇｋｇ－１／ｒｎｉｎ比８．７６±０．９９ｍｇｋｇ－１／ｍｉｎ，Ｐ＞０．０５），胰岛素敏感性降低的高血压病人治疗后有１０例（８３．３％）葡萄糖代谢率恢复正常；（３）高血压病人不论是否合并肥胖，只要是     

肺心病患者机械通气停机和静脉滴注硝普钠后心肺功能的…

分别对７例和１２例机械通气肺心病患者研究了停机和静脉滴注（静滴）硝普钠后血气、血流动力学和氧运输的变化。停机后肿血管阻力（从４８．４±１６．６降至３７．６±１８．５ｋＰａ·ｓ＾－１·１＾－１，Ｐ＜０．０１，１ｋＰａ＝７．５ｍｍＨｇ）明显降低，混合静脉血氧分压（从５．３５±０．７１升至６．００±０．８９ｋＰａ，Ｐ＜０．０１）明显升高。虽然静滴硝普钠后动脉血氧分压（从１２．２０±４．２４降至１０．０７     

经皮球囊肺动脉瓣成形术治疗先天性肺动脉瓣狭窄20例报告

采用经皮球囊肺动脉瓣成形术治疗先天性肺动脉瓣狭窄20例。术前右心室收缩压力13.72±4.44kPa,跨瓣压差为10.02±4.64kPa;扩张后则分别为7.50±3.25kPa和3.59±2.72kPa。8例术后3～6个月复查右心导管,跨瓣压差与扩张后即刻比较无显著差别。并对本术的适应证、方法、并发症进行了探讨。     

比索洛尔治疗228例原发性高血压患者的临床观察

从１９９６年２月至１２月,使用比索洛尔对２２８例高血压病患者进行临床观察。结果表明：治疗前、治疗后２周、４周、６周的收缩压分别为２２２８±２１６ｋＰａ（１６７１±１６２ｍｍＨｇ）、１９９９±２２２ｋＰａ（１４９３±１６７ｍｍＨｇ）、１８９０±１８５ｋＰａ（１４１８±１３９ｍｍＨｇ）、１７９３±１７２ｋＰａ（１３４５±１２９ｍｍＨｇ）,舒张压分别为１３９１±０９５ｋＰａ（１０４３±７１ｍｍＨｇ）、１２３１±１２７ｋＰａ（９２３±９５ｍｍＨｇ）、１１７１±１０７ｋＰａ（８７８±８０ｍｍＨｇ）、１１５２±１０７ｋＰａ（８６４±８０ｍｍＨｇ）。治疗前后比较,均有显著差异,Ｐ＜００１。表明比索洛尔治疗高血压病疗效明显,其显效率为８２０％,总有效率为９４３％,无效率为５７％。说明比索洛尔对原发性高血压病人有良好的降压作用,且副作用少。不同剂量达到降压目标例数不同,其中以５ｍｇ和１０ｍｇ达到降压目标例数最多,分别是１０２例及７８例。说明多数病人用药剂量在５～１０ｍｇ之间即可达到满意的降压效果。     

经皮穿刺二尖瓣球囊成形术术后及随访结果

采用Ｉｎｏｕｅ及国产球囊对４１例患者施行了经皮穿刺二尖瓣球囊扩张术（ＰＢＭＶ），成功的４０例平均左房压由术前的１５．７±３．１ｍｍＨｇ降到６．７±２．９ｍｍＨｇ（Ｐ＜０．００１），跨瓣压差由术前的１３．１±２．１ｍｍＨｇ降到４．５±２．４ｍｍＨｇ（Ｐ＜０．００１），二尖瓣口面积由术前的１．１０±０．２５ｃｍ２增加到１．９９±０．２７ｃｍ２（Ｐ＜０．００１），左房内径由４５．８±５．３ｍｍ减少到４１．２±４．９ｍｍ（Ｐ＜０．０５），心功能由术前的３．１０±０．６２级改善到１．５８±０．７４级（Ｐ＜０．０１）。２４例随访９±５个月结果示除２例发生再狭窄外，其余病例与术后３天相比，二尖瓣口面积和心功能无明显改变，左房内径进一步下降到３８．２±４．６ｍｍＨｇ（Ｐ＜０．０５）。表明，ＰＢＭＶ的近远期效果良好。     

经皮球囊肺动脉瓣成形术60例临床分析

目的 :通过对 60例接受经皮球囊肺动脉瓣成形术 (PBPV)的肺动脉瓣狭窄 (PS)患儿临床分析以评价PBPV治疗PS的安全性和有效性。方法 :选择单纯型PS患儿 60例 ,均常规进行PBPV治疗 ,比较PBPV前后患儿肺动脉瓣跨瓣压差 (PG)和肺动脉瓣上最大流速 (Vmax)等血流动力学指标及心脏体征变化并进行 6个月 ,12个月及长期随访。结果 :5 9例患儿经PBPV治疗全部成功且无明显并发症 ,仅 1例因肺动脉瓣发育不良PBPV后效果差行外科手术治疗。 5 9例患儿PBPV后PG和Vmax均较术前明显降低 ( 76.3 6vs 2 5 .0 6mmHg ,4 4 5 .16vs 2 71.4 7cm s ,P <0 0 1)且PBPV后心脏杂音明显减轻。在术后 6个月 ,12个月及长期随访中 ,PG和Vmax与术前相比有明显差异 ,无再狭窄发生。术后 6～ 12个月内PS继发的右心扩大和右室肥厚恢复至正常水平。结论 :经皮球囊肺动脉瓣成形术治疗单纯型肺动脉瓣狭窄疗效肯定、安全且远期预后好 ,是PS的首选治疗方法     

超声心动图对肺动脉瓣狭窄患儿外科矫治术后跨瓣压差的随访分析

目的 采用超声心动图对肺动脉瓣狭窄患儿外科矫治术后跨瓣压差进行随访分析。方法 2007年11月至 2015 年 11月于四川省人民医院、武汉亚洲心脏病医院共纳入年龄6月～14岁肺动脉瓣狭窄患儿34例,其中单纯肺动脉瓣狭窄4例,合并房间隔缺损17例,卵圆孔未闭7例,室间隔缺损6例,三尖瓣中重度返流5例,分别于外科手术前、术后1周、1～3月及1年后进行超声心动图检查,观察跨肺动脉瓣血流速度、跨瓣压差变化。结果 患儿术前平均跨肺动脉瓣血流速度为5.02&#177;1.02 m/s,跨瓣压差为104.09&#177;43.05 mmHg,术后1周、1～3月及1年后平均跨肺动脉瓣血流速度分别降至2.21&#177;0.66 m/s、1.96&#177;0.58 m/s、1.71&#177;0.45 m/s,跨瓣压差分别降至21.29&#177;12.63 mmHg、16.65&#177;8.90 mmHg、12.53&#177;6.42 mmHg,均较术前明显下降（P&lt;0.05）,患儿临床症状、心功能改善。 结论 外科手术是肺动脉瓣狭窄患者（尤其是合并其他心内畸形者）的重要治疗方式,同时超声心动图是肺动脉瓣狭窄患者瓣膜狭窄程度以及疗效随访的重要评价手段。     

Isolated aortic valve replacement in an advanced stage of cardiac failure. Results and prognostic study apropos of 71 cases

Between January 1970 and December 1982, seventy-one patients in functional Stage IV of the NYHA classification underwent isolated aortic valve replacement for aortic incompetence (27 cases), aortic stenosis (18 cases) or mixed aortic valve disease (26 cases). Three haemodynamic criteria were chosen: left ventricular ejection fraction less than 40% (average 34 +/- 2%); arteriovenous difference greater than 6 volumes per 100 ml (average 6.7 +/- 0.2 vol.); left ventricular end diastolic pressure greater than 20 mmHg (average 26 +/- 1.3 mmHg). Analysis of the preoperative data defined the clinical profile of these patients: average cardiac index 2.2 +/- 0.07 l/min/m2; 75% had a cardiothoracic index greater than 0.50%; 61% had at least one conduction defect. The average Sokolow index was 50 +/- 2 mm. Twenty seven of the 71 patients died (36%); there were 7 early postoperative deaths (1st month) (10%), mainly due to ventricular arrhythmias (6 out of 7). There were 20 late deaths (31%) on average 52 +/- 8 months after surgery: 70% were of cardiac origin with a predominance of sudden deaths. There were no deaths in the group of patients operated after 1977, probably because of improved techniques of peroperative myocardial protection. The actuarial survival was 72% at 5 years and 63% at 10 years: long term survival was lower in aortic incompetence (25% at 10 years) compared with aortic stenosis (68%) and mixed aortic valve disease (78%). There was a significant relationship between long term survival and cardiothoracic ratio, ejection fraction, the duration of symptoms before surgery and the presence of atrioventricular or left bundle branch block.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pulmonary valvuloplasty. Long term results at the Centro Medico la Raza]

The purpose of this study was to evaluate the immediate and long term results of pulmonary valve ballon dilation, and to determine the prognostic factors of failure in 109 patients (60 female and 49 male), aged 7.04 +/- 8.4 years. Seventy two patients (66.1%) had isolated valvular stenosis and 33.9% presented associated lesions. Peak systolic pressure gradient across the pulmonary valve decreased from 89.53 +/- 37.23 to 20.8 +/- 19.41 mmHg (p < 0.0001) after valvuloplasty. Forty three patients developed reactive infundibular stenosis after valvuloplasty with a systolic gradient of 19.65 +/- 35.64 mmHg. At a mean period of 8 years of follow-up the pressure gradient was 20.75 +/- 14.32 (p < 0.001). Valvuloplasty was successful in 86.2% of the cases with a global mortality of 1.9%, minor complications in 15.2%, and a failure rate of 13.8%. At follow-up restenosis developed in 6.7%. The comparative analysis between the groups of success and failure yield as significant risk factors for failure an age younger than 3.5 years and a pulmonary valve with displastic (p < 0.05) or combined morphology (p < 0.05). This group had also more complications and higher systolic gradients and right ventricular pressures post-dilation (p < 0.05). Pulmonary valvuloplasty is a safe and effective procedure for the treatment of pulmonary valve stenosis with a good immediate and long-term results, and is now considered the treatment of choice.     

Balloon pulmonary valvuloplasty after initial pulmonary valvotomy for pulmonary atresia with intact ventricular septum]

Seven patients with pulmonary atresia and intact ventricular septum have undergone closed pulmonary valvotomy on the early neonatal period (2-6 days) with satisfactory results. Follow-up catheterization showed significant residual pulmonary valve stenosis requiring a second operation. Percutaneous balloon dilatation of the pulmonary valve was successful in 6 cases with the mean right ventricular systolic pressure reduced from 6.8 to 4.9 kPa (50.8 to 37 mmHg) and the mean transvalvular gradient dropped from 5.7 to 2.1 kPa (4.28 to 15.8 mmHg). One case failed and required surgical treatment. The results showed that balloon valvuloplasty could be applied instead of surgery for treatment of selected cases of pulmonary atresia with intact ventricular septum after an initial pulmonary valvotomy.     

Direct atriopulmonary anastomosis (modified Fontan) for single ventricle and its equivalents

The modified Fontan procedure is being used in an increasing number of complex cyanotic cardiac lesions with pulmonary stenosis. Seven patients aged 11 to 24 years (average 17.5 years) underwent surgery by a technique derived from the Fontan procedure: direct atriopulmonary anastomosis without a tube or valve. The tricuspid valve when patent was closed with a patch. The diagnoses were: single ventricule (4 cases), Taussig-Bing anomaly (2 cases) and tricuspid atresia (1 case). All patients had associated pulmonary stenosis with low pulmonary vascular resistances. The great vessels were in L-malposition in 3 cases. The hospital mortality was nil. Transient atrial fibrillation was observed in 2 cases and was well tolerated clinically. The follow-up period ranges from 2 months to 4 years (average 2.3 years). All patients are acyanotic with no signs of right-sided failure and in sinus rhythm. Control cardiac catheterisation and angiography were performed in 6 cases and showed good function of the anastomosis and a mean atrial pressure of 14 mmHg. Direct atriopulmonary anastomosis offers a very acceptable surgical solution to certain forms of single ventricle or equivalent with low pulmonary pressures. The short and medium term results seem to be better than those of intraventricular repair.     

Pulmonary valvuloplasty in adolescents and adults: 2 year follow-up by continuous Doppler

The purpose of this study is the long term follow-up of the first pulmonary valvuloplasties performed by our group. From september 1984 to march 1988, 10 patients (4 men and 6 women) aged 8 to 58 (mean: 21) with severe or moderate pulmonary valve stenosis underwent pulmonary valvotomy. In all cases the balloon diameter was equal to or 1 mm smaller than the valvular annulus. The results were satisfactory with a significant mean gradient reduction of 51.7%. A follow-up gradient estimation by Doppler echocardiogram was obtained 10 to 37 months after valvuloplasty (mean: 23 months). The mean follow-up gradient by Doppler (31.3 +/- 9.9 mmHg) was not significantly different from the mean hemodynamic post-dilatation gradient (35.6 +/- 14.7 mmHg). A linear correlation was found between the post-dilatation hemodynamic mean gradient and the mean gradient by Doppler follow-up (r = 0.66, p less than 0.05, SEE = 4.1 mmHg). No restenosis were observed. These results suggest that the benefits of valvuloplasty are long lasting. Continuous Doppler is an excellent technique for the follow-up of these patients.     

Long-term results of pulmonary balloon valvulotomy in adult patients.

BACKGROUND AND AIM OF THE STUDY: The study aim was to define the long-term outcome of pulmonary balloon valvulotomy (PBV) in adult patients. METHODS: PBV was performed in 87 patients (46 females, 41 males; mean age 23+/-9 years; range: 15-54 years) with congenital pulmonary valve stenosis (PS). Intermediate follow up catheterization (mean 14.6+/-5.0; range: 6-24 months) was performed after PBV in 53 patients. Clinical and Doppler echocardiography examinations were carried out annually in 82 patients (mean 8.0+/-3.9; range: 2-15 years). RESULTS: There were no immediate or late deaths. The mean catheter peak pulmonary gradient (PG) before and immediately after PBV, and at intermediate follow up was 105+/-39, 34+/-26 (p <0.0001) and 17+/-14 (p <0.0001) mmHg, respectively. The corresponding values for right ventricular (RV) pressure were 125+/-38, 59+/-21 (p <0.0001) and 42+/-12 (p <0.0001) mmHg, respectively. The infundibular gradients immediately after PBV and at intermediate follow up were 31+/-23 and 14+/-9 mmHg (p <0.0001), whilst cardiac index improved from 2.68+/-0.73 to 3.1+/-0.4 l/min/m2 (p <0.05) at intermediate follow up. Doppler PG before PBV and at intermediate and long-term follow up were 91+/-33 (range 36-200) mmHg, 28+/-12 (range 10-60) mmHg (p <0.0001) and 26+/-11 mmHg (p = 0.2), respectively. New pulmonary regurgitation (PR) was noted in 21 patients (25%) after PBV. Five patients (6%) with a suboptimal result (immediate valve gradient > or =30 mmHg) developed restenosis and underwent repeat valvulotomy 6-12 months later using a larger balloon, and with satisfactory outcome. Moderate to severe tricuspid regurgitation (TR) in seven patients regressed after PBV. CONCLUSION: The long-term results of PBV in adults are excellent, with regression of concomitant, severe infundibular stenosis and/or severe TR. Hence, PBV should be considered as the treatment of choice for adult patients with PS.     

Balloon dilatation of the pulmonary valve. Short-, middle- and long-term results

BACKGROUND: Immediate and long-term results after balloon dilatation of pulmonary valve stenosis in our unit. METHODS AND PATIENTS: All 111 patients (1 day-18 years) who have had balloon dilatation of a pulmonary valvar stenosis between 12/1987 and 8/1997 were divided into 4 groups: Typical valvar pulmonary stenosis (group A; n = 78), stenosis with dysplastic pulmonary valve (group B; n = 10), critical pulmonary stenosis (group C; n = 16) and pulmonary atresia after transcatheter or operative opening of the valve (group D; n = 7). Patients with pulmonary stenosis and complex congenital heart disease were excluded. RESULTS: The average systolic transvalvular gradient was reduced from 68.5 to 27.2 mmHg (60%) immediately after balloon dilatation. After a follow up of 48.8 +/- 37 months 101 patients could be reevaluated. In group A (n = 69 at FU) and C (n = 16 at FU) 81% showed a systolic transvalvular gradient < 30 mmHg after one and 83% (A) respective 94% (C) after two balloon dilatations. In group B (n = 9 at FU) 44% exhibited a systolic gradient < 30 mmHg after one and 56% after two balloon dilatations. In group D (n = 7 at FU) 57% showed a systolic gradient < 30 mmHg with no further improvement by a second dilatation. Over all, 80% of our patients could be treated sufficiently by transcatheter means. The rate of major complications was 7.3% with no lasting residuals at follow up and no deaths. CONCLUSION: Balloon dilatation of the pulmonary valve is secure and effective. Best results are obtained in patients with typical pulmonary valve stenosis and in newborns and infants with critical pulmonary valve stenosis.     

采用10F国产球囊导管介入治疗体重≥10kg儿童肺动脉瓣狭窄

目的评价采用10 F国产球囊导管经皮扩张成形术治疗体重≥10 kg儿童先天性肺动脉瓣狭窄的安全性及有效性。方法 2009年5月至2014年6月,在阜外心血管病医院实施经皮肺动脉瓣球囊成形术(PBPV)患者83例,年龄1~12(4.5±2.8)岁,体重10~60(20.3±9.4)kg。对其适应证、操作技术、导管资料、并发症及超声心动图测量跨肺动脉瓣收缩压差和肺动脉瓣反流情况进行分析。44例术后随访6~44个月。结果技术成功率100%,术后跨肺动脉瓣收缩压由(67.7±26.2)mmHg(1 mmHg=0.133 kPa)下降至(15.4±11.6)mmHg(P0.01)。2例(2.4%)发生右心室流出道激惹,术后6个月均缓解,未见严重肺动脉瓣反流、三尖瓣损伤及再次介入治疗患者。结论采用10 F国产球囊导管介入治疗体重≥10 kg儿童先天性肺动脉瓣狭窄是安全有效的。