Stepwise inoue balloon catheter valvuloplasty for congenital aortic valve stenosis: Comparison with standard balloon catheter technique

Experience with stepwise balloon dilatation of congenital aortic valve stenosis using the new Inoue balloon catheter in 16 patients (aged 12 ±4.6 years; group II) is presented. Results are compared with those obtained in 15 patients (10±6 years; group I) in whom standard balloon catheters were used. The procedure resulted in a similar transvalvar gradient reduction in both groups (83±25 to 34±14 mmHg in group I versus 84±21 to 28±10 mmHg in group II). Significant aortic incompetence occurred in three patients from group I and in four from group II. There was no difference in the average increase in AR grade between the groups. At follow-up (group I, 24±13 months; group II, 7±3 months) there was no significant change in transaortic gradient or aortic incompetence. Balloon aortic valvuloplasty for congenital aortic stenosis carries a risk of aortic incompetence. Stepwise dilatation of the stenosis does not prevent this complication. The Inoue balloon catheter offers technical advantages.     

经皮球囊肺动脉瓣成形术治疗效果和远期随访

为评价经皮球囊肺动脉瓣成形术治疗单纯性肺动脉瓣狭窄患儿的近期和远期效果及影响疗效的因素 ,对经皮球囊肺动脉瓣成形术治疗的167例单纯性肺动脉瓣狭窄患儿进行随访 ,随访时间为术后 (0.6±0.3)年～(8.6±1.5)年 ,以超声心动图测得的右心室与肺动脉之间的跨瓣压差为随访指标。结果显示 ,167例中163例获得成功(成功率为97.6%) ,获成功者术前跨瓣压差为 (87.6±37.4)mmHg,术后立即降为 (35.9±18.5)mmHg,术后2年内跨瓣压差进一步下降 ,5年和8年随访结果表明其远期效果稳定。提示经皮球囊肺动脉瓣成形术安全可靠 ,术后即刻和远期效果好 ,未发生严重并发症     

Balloon valvuloplasty for congenital heart disease: Immediate and long-term results of multi-institutional study

BACKGROUND AND OBJECTIVES: Several studies have been reported in Japan. However, the reports consist of small series at individual institutions. We evaluated the immediate to long-term results of balloon valvuloplasty (BVP) of congenital pulmonary and aortic stenosis at multi-institutions in Japan. METHODS AND RESULTS: Immediate and follow-up data were obtained from eight institutions in Japan. In our series of 172 cases of pulmonary valvuloplasty excluding critical pulmonary stenosis, the mean pressure gradient decreased immediately after BVP from 61+/-27 mmHg to 28+/-20 mmHg and the reduced gradient continued at follow-up in most cases. The BVP for critical pulmonary stenosis could be accomplished in 35 of 39 patients. The mean right ventricular systolic pressure decreased from 102+/-29 mmHg to 62+/-23 mmHg. One of them required the surgical operation for perforation of the right ventricular outflow tract. In BVP for congenital aortic valvular stenosis of 77 cases excluding critical aortic stenosis, the mean pressure gradient decreased immediately after BVP from 68+/-24 mmHg to 34+/-23 mmHg. Thirty-one cases (55%) were free from any interventions in long-term follow-up. The BVP for critical aortic stenosis was performed in 29 neonates. The overall mortality rate was 34% and 24% of the patients required repeat intervention. The remaining 42% was free from any interventions. CONCLUSIONS: Balloon valvuloplasty for congenital pulmonary valvular stenosis is a safe and effective procedure and the initial treatment of choice. In spite of an occasional major complication, BVP for critical pulmonary stenosis is effective in many infants. Balloon aortic valvuloplasty is palliative. However, this procedure has the efficacy in deferring the surgical intervention. Balloon valvuloplasty for neonatal critical aortic stenosis is a useful method to recover from serious conditions.     

经皮球囊肺动脉瓣成形术姑息治疗法洛四联症13例疗效评价

应用经皮球囊肺动脉瓣成形术(PBPV)姑息治疗法洛四联症13例,其中男8例,女5例;平均年龄(3．7±2．1)岁。SaO     

瓣膜发育不良型肺动脉瓣狭窄经皮球囊扩张术治疗的探讨

为探讨瓣膜发育不的狭窄（简称ＰＳ）球囊扩张术（简称ＰＢＰＶ）效果,采用超大球囊法为３４例瓣膜发育不良型ＰＳ进行球囊扩张术。３４例中轻型２１例（平均年龄４．４０岁）,重型１３例（平均年龄５．１５岁）,最小年龄１１月。应用ＰＢＰＶ术球／瓣比值轻型１．３６～１．６４（平均１．１４）,重型１．２０～１．６４（平均１．５２）,术前后观察跨肺动脉瓣压差（△Ｐ）,出院后随访多普勒超专心动图以监测△Ｐ。结果：轻型     

Discrete subaortic stenosis after successful treatment of congenital aortic valve stenosis

Summary Two cases of discrete subaortic obstruction which developed in a previously normal left ventricular outflow tract of patients with congenital valvar aortic stenosis are described. These examples emphasize the need for careful scrutiny of the etiology of recurrent postoperative left ventricular outflow tract obstruction.     

Successful percutaneous balloon valvuloplasty of the aortic valve in an infant

Summary Percutaneous balloon aortic valvuloplasty was attempted in an eight-month-old infant with severe aortic valve stenosis. The procedure resulted in a fall in the resting transvalvular systolic pressure gradient from 106 mmHg to 40 mmHg and no aortic regurgitation. Clinical and Doppler echocardiography findings suggest persistent improved status 3 1/2 months after the procedure.     

小儿主动脉狭窄的心导管及心血管造影检查之评价

为评价心导管及心血管造影检查对小儿主动脉狭窄的诊断价值。应用左右心导管检测心室和大血管压力及血氧饱和度,左、右室及升主动脉造影显示狭窄部位和合并畸形,并以造影与超声心科检查作比较,结果：主动脉瓣上狭窄２５例,８例伴有外周体循环动脉狭窄。１６例伴有外周肺动脉狭窄,３例存在冠状动脉病变;主动脉瓣狭窄４３例,１８例单纯主动脉瓣供穿行球囊瓣膜成形术;主动脉瓣下狭窄４８例,４６合并其他先天性心脏病,仅２例为单纯主动脉瓣下狭窄,说明先天性主动脉瓣上及瓣膜狭窄时心导管及心血管造影仍很有必要,单纯主动脉瓣下狭窄,可不必作心导管和心血管造影。     

Contemporary results of balloon valvuloplasty and surgical valvotomy for congenital aortic stenosis

The purpose of this study was to compare contemporary results of balloon dilatation and surgery for valvar aortic stenosis in infants and children in the five years between August 1988 and October 1993. Thirty four children underwent attempted balloon valvuloplasty (age 1 day-16 years, weight 1720 g-68 kg) (group 1), eight of whom were neonates with critical aortic stenosis. During the same period, 17 children underwent direct surgical valvotomy (group 2) (seven neonates). Successful balloon valvuloplasty was achieved in 33 (97%) with immediate reduction in the instantaneous systolic pressure gradient from 82 to 34 mm Hg (mean). There were two deaths in this group (both neonates), the second in a preterm neonate from necrotising enterocolitis. Complications requiring intervention in group 1 were aortic regurgitation in one and femoral artery injury in two. Follow up from four months to five years showed sustained results in most cases. There were two neonatal deaths in the surgical group. When the two groups were compared there was no significant difference in mortality, morbidity, or need for reintervention within 12 months. Deaths from both groups were attributed to small left ventricles. Hospital stay was significantly shorter in group 1. It is concluded that balloon dilatation for valvar aortic stenosis is effective and safe for the entire paediatric population. The results compare favourably with those of surgery.     

儿童肺动脉瓣狭窄介入治疗术并发症的防治

经皮球囊肺动脉瓣成形术已取代传统手术,成为肺动脉瓣狭窄首选治疗方法.虽然其临床疗效与安全性已得到公认,但仍存在不同程度的并发症,影响预后,甚至致死.该文就经皮球囊肺动脉瓣成形术术中与术后相关并发症的原因及防治措施进行综述.     

6月龄以下小婴儿危重型肺动脉瓣狭窄经皮球囊肺动脉瓣扩张成形术治疗的随访报告

目的 探讨经皮球囊肺动脉瓣扩张成形术(percutaneous balloon pulmonary valvuloplasty,PBPV)治疗新生儿和6月龄以下小婴儿危重型肺动脉瓣狭窄(critical pulmonary stenosis,CPS)的疗效以及早中期随访.方法 采用PBPV治疗34例日龄波动于13～175 d的新生儿以及小婴儿CPS,并进行了6个月～4年的临床随访.记录患儿PBPV前后右室收缩压(right ventricular systolic pressure,RVSP),肺动脉瓣跨瓣压差(transvalvular peak to peak systolic gradient,△P)以及PBPV术后采用心脏彩色多普勒动态监测的肺动脉瓣跨瓣压差的动态变化.结果 34例中32例(94%)完成PBPV术,1例术后2 h内死亡,2例心包积血,3例术中小球囊预扩张后换用合适球囊完成PBPV术,3例右室流出道痉挛,1例术后30 min右下肢股动脉搏动减弱.28例PBPV成功,RVSP由(96±28)mm Hg(1 mm Hg=0.133 kPa)下降至(49±20)mm Hg(下降49%,P＜0.01),△P由(89±25)mm Hg下降到(25±12)mm Hg(下降72%,P＜0.01),右室/主动脉收缩比值1.2±0.5下降到0.7±0.3(P＜0.01).随访6个月～4年,3例失访,5例(其中3例新生儿)因残余压超过40 mm Hg行第二次PBPV术,23例彩色多普勒心脏超声监测肺动脉瓣跨瓣压有进一步下降到(20±13)mm Hg,无明显的肺动脉瓣反流,无需进一步处理.结论 对于6个月以下小婴儿CPS,PBPV仍有效,安全的治疗方法并具有相对好的短中期疗效.

Abstract：

Objective To evaluate the effect and results of short and medium periods of follow-up of percutaneous balloon pulmonary valvuloplasty for critical pulmonary stenosis of neonates and infants under 6 months of age. Methods Between January 2002 and December 2008, 34 consecutive patients aged from 13to 175 days with critical pulmonary valvular stenosis underwent percutaneous balloon valvuloplasty. Patients records, catheterization data, angiograms and echocardiograms were reviewed. Patients were followed up for 6 months to 4 years ( mean 25.5 months ) by means of clinical examination and Doppler echocardiography.Results The pulmonary valvuloplasty was accomplished in 32 (94%) of 34 attempts. Immediately after dilation, right ventricular systolic pressure (RVSP) decreased from (96 ±28) mm Hg ( 1 mm Hg =0. 133kPa ) (49 ± 20 ) mm Hg ( P ＜ 0. 01 ), the transvalvular peak to peak systolic gradient (△P) decreased from (89±25) mm Hg to (25 ± 12) mm Hg (P ＜0.01 ), and the right ventricular/aortic systolic pressure ratio decreased from 1.2 ± 0. 5 to 0. 7 ± 0. 3 ( P ＜ 0. 01 ). One patient died because of cardiac tamponade following rupture of the pulmonary valve annulus, 2 patients developed pericardial effusion, 3 patients had infundibular spasm, 3 patients had a pre-dilation by small balloon and 1 patient had weakened femoral artery pollex. After a follow up period of 6 months to 4 years 3 of 31 patients lost to follow-up. Repeat valvuloplasty was performed in 5 patients (3 neonates), no patient required surgery, and the other 23 patients did not undergo further intervention, a mean peak systolic Doppler gradient of (20 ± 13) mm Hg was found and no significant pulmonary regurgitation was seen. Conclusions Percutaneous balloon pulmonary valvuloplasty was effective and safe for the treatment of critical pulmonary stenosis of neonates and infants under 6 months of age with good short and medium term results.     

儿童先天性主动脉瓣上狭窄的外科治疗

目的 回顾总结儿童先天性主动脉瓣上狭窄(SVAS)的外科治疗经验,提高治疗水平.方法 1990年至2006年10月25例先天性主动脉瓣上狭窄患儿接受手术治疗.其中男16例,女9例,手术平均年龄(5.4±2.4)岁,平均体重(12.6±3.5)kg.影像学检查发现22例为局限性狭窄,主动脉瓣上0.5～2.0 cm处有狭窄段,3例为弥漫性狭窄.平均压力阶差(81.7±21.5)mmHg,William's综合征12例.所有患儿均在体外循环下行补片扩大主动脉成形术,11例以"泪珠"状补片扩大成形修补,14例以"裤衩"状补片扩大加宽主动脉狭窄部.补片材料选择应用自体心包17例,Dacron涤纶补片2例,Gore-tex人工血管补片6例,其中内衬自体心包片1例.对伴发畸形同时加以纠治.结果 术后检查主动脉瓣上流速、压差均明显下降,平均(26.0±13.2)mmHg,住院死亡1例,存活24例.结论 应用"泪珠"状和"裤衩"状补片进行主动脉扩大成形术矫治儿童主动脉瓣上狭窄有效,尤以"裤衩"状补片为首选,婴幼儿补片材料以自体心包为宜.     

Contemporary results of balloon valvuloplasty and surgical valvotomy for congenital aortic stenosis.

The purpose of this study was to compare contemporary results of balloon dilatation and surgery for valvar aortic stenosis in infants and children in the five years between August 1988 and October 1993. Thirty four children underwent attempted balloon valvuloplasty (age 1 day-16 years, weight 1720 g-68 kg) (group 1), eight of whom were neonates with critical aortic stenosis. During the same period, 17 children underwent direct surgical valvotomy (group 2) (seven neonates). Successful balloon valvuloplasty was achieved in 33 (97%) with immediate reduction in the instantaneous systolic pressure gradient from 82 to 34 mm Hg (mean). There were two deaths in this group (both neonates), the second in a preterm neonate from necrotising enterocolitis. Complications requiring intervention in group 1 were aortic regurgitation in one and femoral artery injury in two. Follow up from four months to five years showed sustained results in most cases. There were two neonatal deaths in the surgical group. When the two groups were compared there was no significant difference in mortality, morbidity, or need for reintervention within 12 months. Deaths from both groups were attributed to small left ventricles. Hospital stay was significantly shorter in group 1. It is concluded that balloon dilatation for valvar aortic stenosis is effective and safe for the entire paediatric population. The results compare favourably with those of surgery.     

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??Abstract?? Objective To investigate the diagnosis and management of congenital supravalvular aortic stenosis. Methods Data of 26 cases is collected and analyzed retrospectively?? among which there were mental retardation in 10 cases??growth retardation in 12 cases??positive family history in 2 cases and other heart abnormalities in 4 cases. Results Local supravalvular aortic stenosis was proved in 26 cases by thoracic echocardiography. Catheterization and angiography was performed in 2 cases??and one patient died because of respiration and circulation failure after angiography. Computed tomography angiography was done in 12 cases. Surgical operation was conducted in 13 cases??and 11 patients recovered uneventfully. Of the other two patients??one died during operation??and the other was complicated with brain problem. Conclusions Echocardiography is the basic method for diagnosis; computed tomography angiography and/or catheterization is needed necessarily in establishing diagnosis. Surgical operation is feasible in correcting supravalvular aortic stenosis with satisfied recovery in short-term follow-up??and sometimes pulmonary artery plasty performed if necessary.     

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目的探讨高压球囊扩张术在儿童支气管狭窄临床应用中的疗效及安全性。方法对天津市儿童医院2010年6-12月住院的5例支气管狭窄患儿(包括先天性狭窄1例),经支气管镜进行高压球囊扩张术,每次球囊扩张1～3min,对比术前及末次球囊扩张术后胸片的改变,并定期随访1～6个月。对其临床资料进行回顾分析。结果 5例患儿经高压球囊扩张2～4次,狭窄段支气管管腔明显增宽,临床症状及体征明显改善,复查胸片肺实变及肺不张均有不同程度好转,肺气肿明显减轻。随访1～6个月,4例肺炎肺不张患儿复查胸片基本正常,1例先天性狭窄患儿未再出现高调金属样咳嗽,胸片示肺气肿消失。结论经支气管镜高压球囊扩张术治疗儿童支气管狭窄是一种安全、有效、简便的方法。     

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目的探讨支气管镜下球囊扩张治疗气道狭窄的疗效和安全性。方法对山东大学齐鲁儿童医院呼吸介入科2008年10月至2011年8月收治的156例气道狭窄患儿,实施支气管镜介导下球囊扩张治疗,其中146例肺炎致气道炎性狭窄、4例结核感染引起的气道狭窄、1例异物肉芽组织增生致气道狭窄并肺不张;5例气管插管引起的气道疤痕性狭窄。结果 (1)156例气道狭窄的患儿分别接受支气管镜下球囊扩张1～3次。139例显效,其中134例狭窄段管径增大,肺不张复张2/3以上;5例主气道狭窄经球囊扩张治疗呼吸通畅。12例有效,肺不张经球囊扩张后肺组织复张1/3～2/3。5例无效,虽扩张后局部狭窄解除,但胸部CT肺不张无改善。总有效率96.8%。(2)经1～6个月随访,气管镜下扩张部位气道未再次狭窄,胸片或胸部CT肺不张无复发。(3)26例扩张时扩张部位的支气管黏膜轻微出血,止血效果好,9例术后轻微胸痛未作处理很快缓解,无其他并发症。结论支气管镜下球囊扩张治疗儿童气道狭窄是有效、安全、简便的方法。     

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目的通过分析不同的球瓣比和球囊长度对儿童经皮球囊肺动脉瓣成形术(PBPV)近期及中远期疗效的影响,探讨最适宜的球瓣比和球囊长度。方法1987～2005年山东省立医院儿科诊治119例肺动脉瓣狭窄患儿,使用不同球瓣比和长度的扩张球囊行PBPV术,扩张前后测量右室与肺动脉间的峰值压力阶差,并行左侧位右室造影,测量瓣环大小并观察有无右室流出道激惹。术前、术后定期行经胸超声心动图检查,估测最大跨肺动脉瓣压力阶差,并观察肺动脉瓣形态及其反流情况。结果超大球囊法行PBPV术后,患儿的近期及中远期跨肺动脉瓣压差持续下降,且压差下降率不随球瓣比的增加而增大;术后未发现有肺动脉瓣再狭窄者,所有患儿均有不同程度的肺动脉瓣反流,且反流的程度随时间的延长而加重,并与球瓣比成正相关。对于年龄较小(≤6岁)的儿童,球瓣比大且长度≥40mm的球囊较易引起右室流出道痉挛及三尖瓣反流。中远期三尖瓣反流的发生可能间接继发于肺动脉瓣反流所引起的右室容量负荷过重。结论PBPV治疗肺动脉瓣狭窄,最佳的球瓣比为1.0～1.2,疗效满意且并发症少;6岁以下儿童宜使用长度<40mm的球囊,可减少右室流出道痉挛及近期三尖瓣反流的发生。     

Doty法矫治小儿先天性主动脉瓣上狭窄的疗效

目的 总结Doty法矫治小儿先天性主动脉瓣上狭窄的临床疗效.方法 2009年1月至2013年6月,Doty法矫治小儿先天性主动脉瓣上狭窄12例,其中合并Williams综合征5例.其中男9例,女3例;年龄9个月～12岁[(5.3±4.2)岁];体质量7.5～ 32.0(11.5±5.3)kg.心脏超声和增强CT明确诊断,局限型9例,弥散型3例;跨主动脉瓣上收缩压差6.86 ～16.23(11.07±3.68) kPa,压差＞13.33 kPa者3例;合并左、右肺动脉分支狭窄3例,主动脉瓣二瓣化2例,主动脉瓣轻度返流2例,动脉导管未闭2例,轻度狭窄1例,主动脉瓣下膈膜1例,肺动脉瓣狭窄1例.1例二尖瓣中-重度关闭不全.12例患儿均在全麻体外循环下行Doty法矫治术,并处理合并畸形.结果 体外循环时间68～ 129(85±26) min;主动脉阻断时间43 ～68(51±16) min.术后早期无死亡,无严重低心排出量综合征;5例轻度ST段改变,3例偶发期前收缩;呼吸机应用7～58 h,心脏重症监护室治疗时间1 ～5 d;超声心动图检查提示跨主动脉瓣上收缩压差1.01 ～3.76(2.18±1.09) kPa;有效随访患儿11例,随访6个月～3年,无死亡,无头晕、心悸.除2例患儿外,其余残余压差均低于3.33 kPa.结论 Doty法治疗小儿先天性主动脉瓣上狭窄可获得满意的疗效.     

Percutaneous balloon dilatation of discrete subaortic stenosis as a palliative procedure to promote recovery of left ventricular contractile function

Summary This case report describes the use of percutaneous balloon dilatation of a discrete subaortic membrane as a palliative procedure to improve left ventricular contractile function.