一岁内重度肺动脉瓣狭窄经胸肺动脉瓣球囊扩张成形术疗效分析

Transthoracic Balloon Valvuloplasty for Severe and Critical Pulmonary Valve Stenosis in Infants below One Year

目的总结经胸肺动脉瓣球囊扩张成形术对低龄婴儿重度肺动脉瓣狭窄的即刻疗效及近中期随访结果,探讨一站式肺动脉瓣球囊扩张术的有效方法。方法 2006年3月至2010年3月,阜外心血管病医院采用经胸肺动脉瓣球囊扩张成形术治疗32例重度肺动脉瓣狭窄婴儿患者,男23例,女9例;月龄5 d^11个月(4.59±3.21个月);体重2.3~10.5 kg(6.48±2.05 kg)。均在全身麻醉、气管内插管和超声引导下进行肺动脉瓣球囊扩张。术后随访超声心动图,测量肺动脉瓣跨瓣压差,评估肺动脉瓣反流程度。结果手术成功率为100%,均未出现严重并发症,术后血流动力学稳定,跨瓣压差由术前的82±27 mm Hg下降至23±12 mm Hg(t=15.28,P<0.05);4例患者出院时复查超声心动图提示:跨瓣压差仍高于40 mm Hg。所有患者三尖瓣反流均明显改善,无反流17例,微小量反流13例,中量反流2例;血氧饱和度均大于95%。随访1个月~4年(16±11个月),疗效满意,所有患者均生长发育良好,肺动脉瓣跨瓣压差17±10 mm Hg,仅1例肺动脉瓣跨瓣压差大于40 mm Hg;发生肺动脉瓣反流24例,主要为少量反流23例,仅1例中量反流。结论经胸肺动脉瓣球囊扩张成形术是治疗新生儿及婴幼儿重度肺动脉瓣狭窄一种安全有效的方法。

Objective To summarize the immediate effects and the near and mid-term follow-up results of transthoracic balloon valvuloplasty for newborns and infants with severe and critical pulmonary valve stenosis to find out an effective plan for one-stop balloon valvuloplasty.Methods From March 2006 to March 2010,32 patients including 23 males and 9 females with severe and critical pulmonary valve stenosis were treated in Fu Wai Hospital.Their age ranged from 5 days to 11 months（4.59±3.21 months）.Weight of the patients ranged from 2.3 to 10.5 kg（6.48±2.05 kg）.Dilatation was performed under general anesthesia with intubation and the guidance of echocardiography.During the follow-up period,all survivors had serial echocardiographic assessment to measure the transpulmonary pressure gradient（TPG） and the degree of pulmonary regurgitation.Results All operations were successful with no severe postoperative complications.Hemodynamic indexes were stable after operation with TPG lowered from from 82±27 mm Hg preoperatively to 23±12 mm Hg postoperatively（t=15.28,P0.05）.Only 4 patients had a TPG of more than 40 mm Hg on echocardiography before leaving the hospital.Tricuspid regurgitation was decreased significantly with 17 cases of non-regurgitation,13 cases of light regurgitation and 2 cases of moderate regurgitation.Saturation of peripheral oxygen in all the patients increased to higher than 95%.Follow-up time ranged from 1 month to 4 years（16±11 months）.The results of the follow-up were satisfying for all the patients.The average TPG was 17±10 mm Hg with only one above 40 mm Hg.Pulmonary valve regurgitation was found in 24 patients including 23 with light pulmonary regurgitation and 1 with moderate regurgitation.Conclusion Transthoracic balloon valvuloplasty for newborns and infants with severe and critical pulmonary valve stenosis is safe and effective.