超大球囊肺动脉瓣成形术后疗效及右心室容量变化的远期观察

Influence of Oversized Percutaneous Balloon Pulmonary Valvuloplasty on Right Ventricular Volume and Function

目的：探讨超大球囊肺动脉瓣成形术的球／瓣比与术后压差下降和容量变化间的关系。材料和方法：本文随机选择１９８９年６月—１９９４年３月间在我院行超大球囊法肺动脉成形术的单纯肺动脉瓣狭窄患儿１１例（男５例，女６例，年龄３．５～１１岁）。检测术后导管实测跨瓣压差下降率，及术后３个月、２年后超声法估测压差下降率及用超声长度法检测术后２年后右室舒张末收缩期容量。结果：本组术前右室与肺动脉压力峰值差为６．８４±１．８３ｋＰａ，术后即刻导管法测值为２．３９±２．２７ｋＰａ，两者间有非常显著差异。术后３月超声随访压差（２．５２±０．８６ｋＰａ）与术后＞２年超声随访压差（２．１４±０．７９ｋＰａ）间无显著差异。１１例中均有轻～重度的肺动脉瓣返流。术后２年后右室收缩末、右室舒张末容量（ＲＶＥＳＶ、ＲＶＥＤＶ）均明显高于正常、但右室功能正常。ＲＶＥＤＶ较未手术组的扩大率与球／瓣比间有非常显著相关（Ｐ＜０．０１），ＲＶＥＳＤ扩大率与球／瓣比间有相关趋势，但球／瓣比与术后即时、３月、＞２年的ΔＰ↓率间无显著相关（Ｐ＞０．０５）。结论：表明在超大球囊法肺动脉成形术时，盲目提高球／瓣比无助于提高手术即刻及中、长期效果，反而易致右室扩大。

Purpose:Determine the impact of the ratio of balloon diameter to pulmonary valve diameter (DB/Dp ratio) on the postoperative outcome,right ventricular volume and function in oversized percutaneous balloon pulmonary valvuloplasty (OPBPV).Material and Methods:11 patients (5 male,6 female,aged 3.5 11 years) with simple pulmonary valve stenosis undergone OPBPV were random collected between June 1,1989 and June 1,1994 at XinHua hospital.Peak systolic pressure gradients from the right ventricle to the pulmonary artery before and immediately after OPBPV were measured by catheterization.Doppler estimated the postoperative pressure gradients between right ventricular and pulmonary artery at 3 months and 2 years after OPBPV,respectively.Right ventricular volume and function were estimated at 2 years after OPBPV using Length method,and compared with control group.Results:The DB/Dp ratio ranged from 1.15 to 1.5 (1.32±0.10).Peak systolic pressure gradients from right ventricular to pulmonary artery significantly decreased from 6.84±1.83 kPa to 2.39±2.27 kPa after OPBPV (P<0.01).There was no significant difference between the gradients at 3 months after OPBPV (2.52±0.86kPa) and that at 2 years after (2.14±0.79kPa).At 2years after OPBPV,right ventricular end diastolic volume (RVEDV) and end systolic volume (RVRSV) were still significantly bigger than control group (P<0.01) in all patients but right ventricular ejection fraction was normal,RVEDV dilatant rate correlated very well with DB/Dp ratio significantly.No significant correlation was found between DB/DP ratio and pressure gradients decreasing rate at immediately after,3 months and 2 years after OPBPV,respectively.Conclusion:In OPBPV,higher DB/DP ratio does not provide better immediate and long term relief of pulmonary valve obstruction,but causes right ventricular dilatation.