经皮肺动脉瓣球囊扩张成形术治疗小婴儿重度肺动脉瓣狭窄

目的 回顾性总结经皮肺动脉瓣球囊扩张成形术(PBPV)在重度肺动脉瓣狭窄小婴儿中的即刻治疗效果及6～32个月随访情况.方法 分析2006年6月至2008年8月复日.大学附属儿科医院行PBPV的18例6个月以内重度和极重度肺动脉瓣狭窄小婴儿.年龄8 d～6个月(86 ±63)d,其巾极重度肺动脉瓣狭窄11例,包括2例新生儿.12例采用全身麻醉,6例采用骶管加静脉复合麻醉.球囊直径为5～15 mm,其中6例患者应用2个球囊依次进行扩张,10例患者应用1个球囊扩张.结果 18例患儿中,2例因导管或球囊未能通过肺动脉瓣放弃扩张,余16例扩张成功,成功率88.9%.扩张后即刻导管测右心室与肺动脉收缩期压差自(87±24)mm Hg降至(30±19)mm Hg(1 mm Hg=0.133 kPa,P<0.01),扩张过程中或扩张后均无并发症发生.随访6～32个月,16例肺动脉跨瓣压差进一步降低或不变,2例逐渐升高,行第2次扩张,再扩张率12.5%;三尖瓣反流随访过程中均减轻共至消失;除1例为中度肺动脉瓣反流外,其余均为轻度;临床均无症状,生长发育良好.结论 经皮肺动脉瓣球囊扩张成形术在重度和极重度肺动脉瓣狭窄小婴儿中应用安全,效果好,并发症少,患儿痛苦小,应作为该类患儿首选治疗方法.

Percutaneous balloon valvuloplasty for severe and critical pulmonary valve stenosis in infants under six months

Objective To assess the effects and potential role of percutaneous balloon valvuloplasty as an alternative therapy of surgery in young infants with severe and critical pulmonary vatve stenosis.Methotis Eighteen patients aged 8 days to 6 months with severe and critical pulmonary vatve stenosis admitted to our hospital from June 2006 to August 2008 underwent batloon valvuloplasty.Among them.11 infants including 2 neonates had critical pulmonary stenosis.Severe tricuspid regurgiiration was seen jn 5 and moderate in 3.Right ventricular systolic pressure in all patients was greater than systemic pressure wilh right-to-left or bi-directional shunt at atrial level.Dilatation was Deriormed under general anesthesia with intubation in 12 patients and caudal block combined with sedation in 6 patients.Dilatation with 2 balloons sequentially in one procedure was performed in 6 patients and dilatation with 1 balloon in other 10 patients.Results Of the 18 patients,there was failure to cross the pulmonary valve with balloon catheter in one and cardiac tamponade in oue.The dilatation success rate was 88.9%.Immediately after dilatation,the systemic pressure gradient from right ventricle to pulmonary artery decreased from (87±24) mm Hg to (30±19)mm Hg(P<0.01).No complication was found in all patients during or post dilation. During a follow-up of 6 to 32 months,pressure gradient crossing pulmonary valve measured by echocardiography further decreased or remained stable iu 16 cases.except one neonate and one infant whose pressure gradient gradually increased and required a second dilatation.Re-dilatation rate was 12.5%.Tricuspid regurgitation was reduced in all patients.Mild pulmonary regurgitation was seen in most of patients post-dilatation.except moderate in one.AIl patients fared well and stayed asymptomatic.Conclusion Percutaneous balloon valvuloplasty for severe and critical pulmonary stenosis in infants is relatively safe and effective and should be considered a vatid alternative to surgicat operation.It should be the first choice for such patients based on its excellent outcome.less trauma and fewer complications.