法乐四联症外科根治术后残余右室流出道梗阻的介入治疗

Transcatheter treatment of residual obstruction of right ventricular outflow tract after radical surgery correction of Tetralogy of Fallot

目的探讨经皮肺动脉瓣球囊成形术(PBPV)处理法乐四联症(TOF)根治术后残余右室流出梗阻(RVOTO)的可行性及临床价值。方法2006年3月～2008年3月,我院共有5例TOF术后残余RVOTO的患者接受了PBPV术,其中男2例,女3例,年龄5～24岁,3例为残余肺动脉瓣狭窄,2例为残余肺动脉瓣下狭窄,所有患者均经股静脉途径采用聚乙烯单球囊法或Inoue球囊法进行PBPV术,介入治疗前后测量肺动脉-右室峰值压差。所有患者介入术后24 h、3个月、6个月复查超声心动图、心电图进行随访。结果5例患者PBPV术均获成功,右室-肺动脉峰值压差平均由术前的61 mm Hg下降至9.6 mm Hg,无严重并发症发生,平均随访7.2个月(平均3～12个月),无再狭窄发生。结论TOF外科根治术后残余RVOTO中的部分病例,可采用PBPV术有效解除梗阻,避免二次手术的风险。

Objectives To evaluate the value of percutanous balloon pulmonary valvuloplasty （ PB- PV） in treatment of residual fight ventricular outflow tract obstruction （RVOTO） after radical surgery correction of Tetralogy of Fallot （TOF）. Methods From March 2006 to March 2008, A total of 5 patients（2 males, 3 females） with residual RVOTO , who aged from 5 to 24 years was attempted with PBPV using polythene balloon or Inoue balloon. A routine follow-up included EKG, UCG was underwent 24hr, 3 months,6 months and 12months. Results Transcatheter procedure was successful in all patients, the peak pressure gradients of fight ventricle to pulmonary artery decreased from 61 mmHg to 9.6mmHg after PBPV. it had no serious complications related to procedure, and no restenosis occurred in follow-up. Conclusion PBPV was a effective procedure to deal with residual RVOTO after surgical correction of TOF, but the ease must be selected.