经皮球囊肺动脉瓣成形术治疗肺动脉瓣狭窄临床观察

Clinical observation on patients with PS after percutaneous ballon pulmonary valvuoplasty

目的观察经皮球囊肺动脉瓣成形术(PBPV)治疗肺动脉瓣狭窄术前、术后肺动脉-右心室收缩压峰值压差的变化,以评估手术效果。方法2004-2007年吉林心脏病医院心内科诊治16例肺动脉瓣狭窄患者,年龄3～57岁。首先通过右室左侧位造影,根据肺动脉瓣环直径选择扩张球囊;用右心导管测肺动脉-右心室收缩压峰值压差及心脏彩超多普勒测跨肺A瓣压差的方法分别测定扩张前、后压差变化;并于术后随访平均(23.2±12.4)个月,以心电图、超声心动、X线为随访指标。结果16例PBPV患者术后即刻肺动脉-右心室收缩压峰值压力阶差由术前的39～203mmHg降至2～95mmHg(P<0.01),术后心脏彩超多普勒测跨肺动脉瓣压差由术前的34～179mmHg降至4～48mmHg(P<0.05)。术后(23.2±12.4)月多普勒测跨肺动脉瓣压差与术前相比差异有统计学意义(P<0.05)。结论PBPV可显著缩小压差,其治疗肺动脉瓣狭窄安全,疗效确切,创伤小,恢复快。

Objective To evaluate the operation effect by observing the pressure changing between pulmonary and right vertricular before and after PBPV in pulmonary valve stenosis.nethods 16 patients with pulmonary valve stenosis were studied, cardiac catheterization were performed to select balloon depending on diameter of pulmonary valve; the pressure of before and after operation between pulmonary and right ventricular were measured by both cardiac catheterization and echocardiaography. All patients were followed up （23.2±12.4） months by ECG, Echocardiography and X-ray. Results Compared to pre-operation, the pressuer difference of post-operation between pulmonary and right ventricurlar were significantly decreased from 39-203mmHg to 2-95 mm Hg（P〈 0.01 ）, the pressure difference messured by color Doppler were Significantly decreased from 34-179 mm Hg（preoperation） to 4-48 mm Hg（P〈0.05）. the pressure difference of both sides of pulmonary valve were significantly decreased 23.2±12.4 months later compared to pre-operation （P〈0.05）. Conclusion PBPV is a safe and effective method to cure pulmonary valve stenosis by decrease pressure difference between pulmonary and right ventricular.