经皮球囊肺动脉瓣成型术姑息治疗婴儿法洛四联症

Palliative therapy for infants with tetralogy of Fallot by percutaneous balloon pulmonary valvuloplasty

目的 探讨采用经皮球囊导管扩张术扩张法洛四联症患儿的右心室出口 ,用以姑息治疗的方法。方法 在心导管室中 ,对月龄 2～ 12个月的 16例法洛四联症患儿 ,以球囊导管扩张其右心室出口处后 ,测量主动脉血氧饱和度 ,右心室及肺动脉的压力。以右心室、肺动脉及 (或 )主动脉摄影 ,分别测量肺动脉环、左肺动脉及右肺动脉第一分枝处、升主动脉及降主动脉的直径 ,以及肺动脉指数 ,3～ 16个月后随访 ,行右心导管检查。结果 (1)术后即刻主动脉血氧饱和度由 0 74增至 0 82(P <0 0 1) ,远期达 0 87;(2 )术后即刻及远期右心室、肺动脉及其两者之间压力差均与术前无明显变化 (P >0 0 5 ) ;(3) 14例远期随访肺动脉环、左肺动脉、右肺动脉第一分枝处直径均明显增大 (P <0 0 0 1) ,升主动脉及降主动脉直径亦明显增大 (P <0 0 5 )。结论 经皮球囊导管扩张狭窄的右心室流出口 ,是对法洛四联症患儿合并缺氧发作的有效姑息疗法之一。

Objective To evaluate the efficacy of palliative therapy for infants with tetralogy of Fallot by percutaneous balloon dilatation of the right ventricalar outflow tract. Methods In cardiac catheterization laboratory, aortic oxygen saturation and pressure in right ventricle and pulmonary arteries were measured in 16 infants aged 2-12 months with tetralogy of Fallot before and after balloon dilatation of the right ventricular outflow tract. The diameters of pulmonary annuli, first branches of right and left pulmonary arteries, as well as ascending and descending aortae were also measured by cineangiography before and after balloon dilatation. Results (1) The oxygen saturation in aortae increased from 0.74 to 0.82 ( P< 0.01) after the balloon dilatation. (2) The pressures in right ventricle and pulmonary arteries didn′t show significant changes ( P> 0.05) after the procedure. (3) The diameters of pulmonary annuli, first branches of right and left pulmonary arteries increased significantly ( P< 0.0001). The diameters of aortae also increased significantly ( P< 0,05) following catheterizations up to one year in 14 of 16 cases. Conclusion The percutaneous balloon dilatation of the stenotic right outflow tract is one of the effective palliative therapies for infants with tetralogy of Fallot.