经皮球囊主动脉瓣成形术治疗小婴儿重症主动脉瓣狭窄的疗效观察

Efficacy of percutaneous balloon aortic valvuloplasty for severe aortic valve stenosis in four infants under three months of age

目的评估经皮球囊主动脉瓣成形术治疗3个月以下小婴儿重症主动脉瓣狭窄的效果。方法2010年6月至2011年3月，随机入选4例年龄在3个月以下，且不合并主动脉瓣环和左心室发育不良的重症主动脉瓣狭窄小婴儿，并进行经皮球囊主动脉瓣成形术。患儿手术时日龄为34～87d，体质量为2．8—4．8kg。患儿在术前和术后即刻均测量主动脉瓣跨瓣收缩期峰压差和左心室射血分数，并观察主动脉瓣反流情况。术后1个月进行临床随访。结果4例患儿术前主动脉瓣环直径7．0—8．8mm，球囊直径／瓣环直径比值为0．86—1．00。超声多普勒测量的主动脉瓣跨瓣收缩期峰压差由术前的（60．6±15．2）mmHg（1mmHg=0．133kPa）下降至术后即刻的（29．5±8．0）mmHg（P〈0．01）；左心室射血分数术前为（47．6±7．5）％，术后即刻为（52．2±18．9）％（P〉O．05）。2例患者在球囊扩张时出现严重的心动过缓，心肺复苏后心率均恢复正常。术后1个月，超声多普勒测量的主动脉瓣跨瓣收缩期峰压差为（36．5±11．0）mmHg，显著低于术前（P〈0．05）；左心室射血分数为（81．0±1．1）％，显著高于术前（P〈0．01）；主动脉瓣反流为轻微至轻度。结论在不合并主动脉瓣环和左心室发育不良的情况下，经皮球囊主动脉瓣成形术是小婴儿重症主动脉瓣狭窄有效的治疗手段。

Objective To evaluate the outcome of percutaneous balloon aortic valvuloplasty （PBAV） for severe aortic valve stenosis in infants younger than 3 months of age. Methods Four infants under the age of 3 months （ranged from 34 to 87 days） underwent PBAV for severe aortic stenosis between June 2010 and March 2011 were included in this study. The weight of infants ranged from 2, 8 to 4. 8 kg. The peak systolic valve gradient, left ventricular ejection fraction （LVEF） and aortic regurgitation were measured in all patients just before and immediately after balloon dilation respectively. Patients were followed-up up to 1 month after PBAV. Results The aortic annulus diameter ranged from 7. 0 to 8.8 ram. The ratio of balloon to aortic annulus diameter ranged from O. 86 to 1.00. PBAV was successful in all cases. The peak systolic valve gradient measured by Doppler echocardiography was （ 60. 6± 15.2 ）mm Hg （ 1 mm Hg =0. 133 kPa） and LVEF was （47.6 ± 7.5）% before PBAV. Immediately after PBAV, the peak systolic valve gradient decreased to （ 29. 5 ± 8. 0 ）mm Hg （ P 〈 0. 01 ） and LVEF increased to （ 52. 2 ± 18.9） % （P 〉 0. 05）. Two patients experienced significant bradycardia during PBAV and restored normal cardiac rhythm after cardiopulmonary resuscitation. At 1 month after PBAV, the peak systolic valve gradient measured by Doppler echocardiography was （ 36. 5 ±11.0） mm Hg （ P 〈 0. 05 vs. pre-PBAV） and LVEF was （81.0 ± 1.1 ）% （P 〈 0. 01 vs. pre-PBAV）. Only trivial to mild aortic regurgitation was detected post PBAV in the 4 patients. Conclusion PBAV is a feasible palliative procedure for infants with isolated aortic valve stenosis without annular or ventricular hypoplasia.