经皮球囊扩张术治疗儿童先天性主动脉瓣狭窄

目的探讨儿童先天性主动脉瓣狭窄（aortic stenosis,AS）球囊扩张的治疗效果。方法选择21例单纯性AS患儿,其中1例合并动脉导管未闭（PDA）,3例因导管难以进入左室,2例左心导管测跨主动脉瓣压力阶差（AP）小于50mmHg（1mmHg=0．133kPa）而未扩张,其余16例采用与瓣环直径之比为0．98±0．04（0．92～1．10）的球囊扩张治疗,合并的PDA予Amplatzer伞片封堵治疗。结果即刻AP下降至原AP50％以上者13例,占81．25％;下降至原AP40％～50％者2例。随访6个月～5年,3例患儿AP回复至50mmHg以上,分别予第二次扩张或外科手术后好转。无一例轻度以上的主动脉瓣反流。结论AS经皮球囊扩张术结果表明,球囊扩张对单纯性AS具有一定疗效,由于其非开胸、方便且较安全地缓解左心室流出道梗阻,从而可替代或延缓外科开胸瓣膜切开术,为AS的治疗提供了另外一种选择。

Percutaneous balloon aortic valvuloplasty for congenital valvular aortic stenosis in children

OBJECTIVE: To assess the effect of the balloon valvuloplasty for congenital valvular aortic stenosis (AS) in children. METHODS: A total of twenty one children with AS accepted the treatment of percutaneous balloon aortic valvuloplasty (PBAV). One of them complicated with PDA underwent PDA closure by using Amplatzer occluder in the mean time. PBAV could not be accomplished in 3 cases because the catheter could not be advanced into left ventricle and PBAV was not performed in 2 cases due to the gradient pressures across aortic valves less than 50 mm Hg (1 mm Hg = 0.133 kPa). The procedure was completed in 16 cases. The ratios of balloon/valve were 0.98 +/- 0.04 (0.92 - 1.10). RESULTS: 13 cases had more than 50% gradient reduction (81.25%), 2 had 40% - 50% gradient reduction. The follow up period ranged from 3 months to 5 years. The gradient pressures rose to more than 50 mm Hg after follow up in 3 cases and they underwent repeat balloon valvuloplasty procedure or were operated successfully. There was no moderate to severe aortic insufficiency (AI). CONCLUSION: The result of balloon aortic valvuloplasty showed the significant hemodynamic improvement with relative safety in pediatric patients. PBAV provides another choice in comparison with surgery.