经皮肺动脉瓣球囊成形术治疗肺动脉瓣狭窄16例体会

目的　评价经皮肺动脉瓣球囊成形术对肺动脉瓣狭窄的治疗效果。临床资料　我院自1998年9月～2 0 0 4年7月共完成16例肺动脉瓣狭窄球囊扩张,女8例,男8例,年龄2～5 8岁,单纯PS9例,合并房缺1例,术前经病史、体格检查、超声心动图等检查确诊。其中术前经多普勒超声估测跨瓣压差。方法　经皮Seldinger穿刺右股静脉成功后,常规行右心导管检查,测跨瓣压差。用6F猪尾巴导管行右室造影:测量肺动脉瓣环直径来选择球囊大小。前7例用J型钢丝经右心导管送至左上或下肺动脉远端,后9例用左房钢丝盘在扩张的肺动脉内。用扩张管扩张皮下及股静脉,前14例用Inoue左房室瓣球囊,后2例用自制肺动脉瓣球囊,参照造影影像定位,将球囊前囊打起,后撤至肺动脉瓣口上,将后囊打起,腰部消失反复扩张2～3次,听诊杂音,撤出左房钢丝,用球囊连续测压,测术后跨瓣压,再次右室造影(取左侧位)。结果　16例患者手术均获成功,术前跨瓣压差2 5～110mmHg,术后跨瓣压12～4 2mmHg ,术前多普勒超声估测跨瓣压差2 4～112mmHg,术后估测跨瓣压差15～4 0mmHg ,其中以重度狭窄者扩张效果最好,有1例术后跨瓣压差为0。但重度狭窄...     

经皮球囊肺动脉瓣成形术治疗单纯性肺动脉瓣狭窄32例

目的 总结1995～2001年我院用经皮球囊肺动脉瓣成形术治疗单纯性肺动脉瓣狭窄32例的经验。方法 本院住院患者32例,单纯性肺动脉瓣狭窄采用经皮球囊肺动脉瓣成形术治疗。结果 本组32例右室收缩压:术前(93.5±28.5)mmHg,术后(42±9.0)mmHg;跨肺动脉瓣压力阶差:术前(76±30)mnHg,术后(24.5±8.5)mmHg;术后跨肺动脉瓣压力阶差<25mmHg达90.6％。结论 经皮球囊肺动脉瓣成形术治疗单纯性肺动脉瓣狭窄是安全有效的,病例和手术方法的选择,精确测定肺动脉瓣直径和选择大小合适的球囊是手术成功的重要环节。     

经皮球囊肺动脉瓣成形术治疗单纯肺动脉瓣狭窄48例

目的 评估经皮球囊肺动脉瓣成形术(PBPV)治疗先天性肺动脉瓣狭窄(PS)的临床疗效.方法 总结近11年经临床、心电图、X线及超声心动图证实为单纯PS 48例.行瓣膜扩张术前先确定PS的类型和测量瓣环大小,球囊直径选择比瓣环径线大20％ ～ 40％,扩张后即刻测肺动脉与右心室跨瓣压差(△P),观察比较PBPV后肺动脉瓣开放、射流及肺动脉瓣、右房室瓣反流情况.结果 48例患者中38例采用单球囊,10例双球囊扩张,均扩张成功,无任何严重并发症发生.结论 PBPV是治疗单纯PS安全、有效的介入治疗方法,无严重并发症,已成为治疗PS的首选方法.     

经皮穿刺球囊肺动脉瓣成形术的护理

目的:为探讨经皮穿刺球囊肺动脉瓣成形术患者的护理及预防并发症发生的方法.方法:对151例接受介入治疗的肺动脉瓣狭窄患者进行回顾性分析,并针对各自的并发症实施相应护理对策.结果:151例患者介入治疗技术成功率100%,术中72例出现偶发室早,8例出现短阵室速,2例出现窦性心动过缓;术后有12例出现右室流出道痉挛,151例均有轻度肺动脉瓣反流,住院3天出院,未发现肺动脉瓣有再狭窄者.结论:准确的术前决策,充分的术前准备,积极的术中、术后监护处理,对保证患者顺利通过手术、预防或减少并发症发生有重要意义.     

经皮球囊肺动脉瓣成形术的临床应用

目的:观察经皮球囊成形术治疗肺动脉瓣狭窄的疗效和安全性。方法:男性4例,女性2例,年龄8～19岁,平均11.7岁,均行经皮肺动脉瓣球囊成形术治疗。结果:肺动脉至右心室平均收缩压差由术前9.1kPa降至术后3.6kPa。结论:经皮肺动脉瓣球囊成形术是治疗肺动脉瓣狭窄的首选方法。     

经皮单球囊与双球囊肺动脉瓣成形术的对比观察

作者对经皮单球囊肺动脉瓣成形术１７例和双球囊扩张４０例的效果进行比较。扩张前两组右室收缩压分别为１１．７６±３．９４ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）与１２．６１±４．３３ｋＰａ；跨瓣压差分别为８．１１±３．６８ｋＰａ与８．４０±４．６１ｋＰａ（Ｐ＞０．０５）。扩张后右室收缩压分别为６．４８±１．６６ｋＰａ与７．０５±３．４４ｋＰａ；跨瓣压差分别为２．０１±１．５１ｋＰａ与２．１５±１．７８ｋＰａ（Ｐ＞０．０５）。上述结果提示单球囊与双球囊扩张的效果相同。     

经皮肺动脉瓣球囊成形术与外科治疗单纯性肺动脉瓣狭窄的对比研究

目的　探讨经皮肺动脉瓣球囊成形术 (PBPV)替代外科手术治疗单纯性肺动脉瓣狭窄(IVPS)的可行性。方法　外科组包括 3 1例IVPS患者 ,PBPV组为同期接受PBPV的 14 6例IVPS患者。比较 2种方法的疗效和费用等情况。结果　PBPV组技术成功率为 10 0 % ,无严重并发症发生 ;外科组3 1例全部手术成功 ,无死亡 ,术后出现中量胸腔积液 2例 ,肺不张 1例 ,气胸 1例 ,重度三尖瓣关闭不全 1例。两组间术前、术后及随访中的肺动脉瓣跨瓣压差 (PG)值无显著性差异 ;两组的平均总费用相似 (P >0 .0 5) ,但西药费外科组显著高于PBPV组 ,器材费PBPV组明显高于外科组 (均P <0 .0 5)。结论　PBPV术疗效与外科手术相当 ,但较外科手术有更好的效价比 ,更易被患者所接受 ,PBPV术可以替代外科手术 ,成为治疗IVPS的首选方法     

经皮球囊成形术治疗二尖瓣狭窄93例

应用乳胶尼龙网球囊导管治疗风湿性心脏病二尖瓣狭窄９３例，女６３例，男３０例，平均年龄３８岁。成功９０例结果表明：经皮球囊二尖瓣成形术是治疗二尖瓣狭窄的有方法之一。     

重度二尖瓣狭窄合并左心房附壁血栓患者的经皮二尖瓣球囊成形术

对重度二尖瓣狭窄合并主心房附壁血栓的6例患者进行了经皮二尖瓣球囊成形术(PB-MV)。结果手术均获得成功,无1例发生血栓栓塞性并发症,二尖瓣口面积由0.58±0.15cm~2扩大到1.56±0.24cm~2(P<0.01),左房平均压由3.37±0.89kPa降至2.08±0.83kPa(P<0.01),二尖瓣最大跨瓣压差由4.01±1.95kPa降至2.13±0.91kPa(P<0.01)。心功能由Ⅳ级提高到Ⅲ级4例、Ⅱ级1例,Ⅲ级提高到Ⅱ级1例。我们认为,对已不能耐受开胸外科手术的重度二尖瓣狭窄合并左房心耳部和侧壁的附壁血栓患者,在积极正确的术前准备、掌握好时机和操作熟练的前提下仍可进行PBMV。     

Intraoperative balloon valvuloplasty in pulmonary valve stenosis

Balloon valvuloplasty was used in the operating room on 7 patients to visually assess the valvular changes induced by inflation of a balloon catheter. All patients had typical pulmonary valve stenosis and an associated cardiac condition which necessitated surgery. Of 23 fused commissures present, 21 were successfully opened with a single balloon inflation. In 2 patients, damage to the leaflets was observed. In 1 patient there was partial detachment and in the other a small tear was noted at the margin of one leaflet. These intraoperative results may be similar to the results obtained with percutaneous balloon valvuloplasty.     

106例二尖瓣狭窄经皮球囊成形术分析

本文分析了106例经皮二尖瓣球囊成形术。成功率为77.4％,有效率为19.8％,失败率为2.8％,并发症发生率为17.0％。本文还探讨了并发症和发生原因及予防。我们采用瓣口大小,跨瓣压差,舒张期杂音,心功能和并发症五方面作为评价疗效的标准。最后讨论了球囊导管通过大左房小瓣口的初步经验。     

67例二尖瓣球囊成形术临床分析

经皮二尖瓣球囊成形术治疗二尖瓣狭窄67例,63例成功(94%),术后左房平均压由24+8mmHg 降至15+7mmHg(P<0.001);跨瓣压差由21±9mmhg 降至10±8mmhg(P<0.001);左房内径由49±7mmhg 降至43±7mmhg(P<0.001)二尖瓣口面积由1.1cm±0.2cm 增至2.1cm±0.3cm(P<0.001);心输出量由5.7±1.4升/分增至6.3±1.6升/分(P<0.001)。MR 系影响 PTMV 术的效果的重要因素,术中产生 MR 主要决定二尖瓣病理形态结构,与采用球囊类型无关。术后近期及远期疗效稳定。国产球囊可与进口球囊相媲美。     

Angiographic features associated with percutaneous balloon valvotomy for pulmonary valve stenosis

Changes in the mobility of the pulmonary valve were determined by a retrospective review of right ventricular cineangiograms from 25 balloon pulmonary valvotomy (BV) procedures in 23 infants and children. The angiographic changes were compared with the post-BV catheter and Doppler pressure gradients across the right ventricular outflow tract. Angiographic features felt to indicate valve tearing were present following 17 of 25 procedures and included increased excursion or straightening of leaflets, localized change in leaflet motion (flail leaflet), and the presence of an additional contrast jet through the valve. There was no statistically significant relationship between any of the angiographic parameters and the pressure data. Most patients with marked increase in angiographic valvemobility had low residual right ventricular to pulmonary artery gradients. However, the absence of angiographic change was not always associated with a high residual gradient.     

Direct transaortic balloon valvuloplasty under cardiopulmonary bypass for neonatal critical aortic stenosis

A 1-day-old male infant with critical aortic valvular stenosis underwent balloon aortic valvuloplasty (BAV) under echocardiographic guidance during cardiopulmonary bypass. Left ventricular function dramatically improved after BAV. This technique combined with a surgical approach was safe and efficient.