瓣膜发育不良型肺动脉瓣狭窄经皮球囊扩张术治疗的探讨

Study of percutaneous balloon pulmonary valvuloplasty for the treatment of congenital dysplastic pulmonary valvular stenosis in children

为探讨瓣膜发育不良型肺动脉瓣狭窄(简称PS)球囊扩张术(简称PBPV)效果,采用超大球囊法为34例瓣膜发育不良型PS进行球囊扩张术。34例中轻型21例(平均年龄4.40岁),重型13例(平均年龄5.15岁),最小年龄11月。应用PBPV术球/瓣比值轻型1.36～1.64(平均1.41),重型1.20～1.64(平均1.52),术前后观察跨肺动肺瓣压差(△P),出院后随访多普勒超声心动图以监测△P。结果:轻型中18例(85.7％)效果良好(≤25mmHg),3例(14.3％)1年后△p回升>30mmHg需作第二次球囊扩张;重型中7例(53.8％)效果良好(△P≤25mmHg),其球/瓣比值达1.52±0.12;而术后△p>25mmHg6例(46.2％)球/瓣比值为1.27±2.26。结论:(1)瓣膜发育不良型病变程度是影响PBPV疗效的主要因素;(2)瓣叶明显增厚、充盈缺损、射流消失、无狭窄后扩张者疗效差,轻型疗效良好;(3)超大球囊法(球/瓣比值1.4～1.5)对轻型及部分重型病例获良好效果。

To explore the effect of percutaneous balloon pulmonary valvuloplasty (PBPV) for the treatment of congenital dysplastic pulmonary valvular stenosis (PS) in children, 21 mild (mean aged of 4- 4 years) and 13 severe (mean aged of 5.15 years) children with congenital dysplastic pulmonary valvular stenosis had accepted the treatment of PBPV. The mean ratios of Bolloon/valve were 1. 41 (ranged of 1. 36-1. 64) for mild cases and 1. 52 (ranged of 1. 20-1. 64) for severe cases. The patients were evaluated by the gradients across pulmonary valves in pre-and post-PBPV and by the Doppler ultrasonic cardiography in follow-up duration, respectively. The results showed that 18 (85. 7%) of 21 cases with mild PS got a better outcome (AP<i25mmHg) and the rest 3 cases (14. 3%) had undergone the increase in AP after one year of PBPV (AP> 30mmHg), so that second PBPV had to be needed on whom. The prognosis in 7 (53. 8%) of 13 cases with severe PS was good (ΔP≤25mmHg), and their ratio of the Bolloon/valve was 1. 52±0.12. The rest 6 cases whose AP were more than 25 mmHg and the Balloon/valve ratio was 1. 27 ±2. 26 had a poor outcome. It is concluded that the effect of PBPV can be influenced by the severity of PS. It seems that the oversized balloons (Balloon/valve is 1. 4-1. 5) is available for the mild PS and the part severe PS.