Inoue球囊瓣膜成形术治疗儿童先天性肺动脉瓣狭窄22例

目的探讨先天性肺动脉瓣狭窄病例经皮穿刺Inoue球囊肺动脉瓣成形术的体会。方法患儿22例。男10例,女12例。年龄9.5~14.0(11.2±2.6)岁,先行右室造影及右心导管检查,测量压力及肺动脉瓣环直径,应用Inoue环形导丝建立钢丝轨道,使导丝前端在肺动脉形成自然圆圈状以固定轨道钢丝。选用最大径较肺动脉瓣环直径大20%~40%Inoue球囊进行扩张。结果本组22例均扩张成功。5例术后出现反应性右室流出道狭窄,经药物治疗后好转。1例出现三尖瓣乳头肌断裂,经外科治疗痊愈。结论对于较大儿童应用Inoue球囊进行肺动脉瓣成形术治疗效果良好,但应严格掌握操作程序。

Percutaneous Balloon Valvuloplasty with Inoue- Balloon in 22 Children with Congenital Pulmonary Valve Stenosis

Objective To report the experience of percutaneous balloon pulmonary valvuloplasty(PBPV) with inoue-balloon in children with congenital pulmonary valve stenosis.Methods There were 10 males and 12 females,aged from 9.5 to 14.0 years old,which with pulmonary valve stenosis received PBPV.Under heavy sedation or local anesthesia,right heart catheterization and right ventriculography performed.The suitable inoue-balloon of which the diameter was 20%-40% larger than pulmonary valve ring was chosen.After the tract guide wire from right femoral vein to pulmonary atery established,inoue-balloon pushed to pulmonary trunk along the guide wire and expanded with radiopaque contrast medium.Results PBPV were successful in all 22 cases.Five cases expressed reactive right ventricular outflow tract stenosis,and with inderal therapy;the reactive stenosis relieved in follow-up studies.One case complicated with papillary muscle rupture of tricuspid valve,which was healed by surgical process.Conclusions PBPV with inoue-balloon was an effective and mini-traumatic method in older children with pulmonary valve stenosis.To avoid complications,indications of interventional therapy must be obeyed.