先天性主动脉瓣狭窄的介入治疗进展

Progress of interventional therapy of congenital valvular aortic stenosis

先天性主动脉瓣狭窄（AS）是由于主动脉瓣胚胎期发育异常而导致的左心室流出道梗阻性病变,1983年经皮球囊主动脉瓣成形（PBAV）术首次应用于先天性AS的治疗.近30年来,由于介入材料和方法学的进展以及临床经验的积累,PBAV术的有效性和安全性被进一步证实,目前已成为先天性AS的首选治疗方法之一,但对于不同的患者,尤其是新生儿重症AS患者,需要根据患者的具体情况正确选择手术方法和手术指征.PBAV术治疗先天性AS可获得良好的即期效果,有效缓解左心室流出道的梗阻,中长期随访仍有相当的效果,但绝大多数患者随着年龄的增长会山现再狭窄和/或进行性主动脉瓣反流,需要再次手术,甚至主动脉瓣置换术.PBAV术是先天性心脏病介入治疗中并发症相对较多、手术风险相对较大的操作之一,需要有熟练的技术、精确的判断和及时处理危急状态的能力.PBAV术是先天性AS的一种姑息治疗方法,术后需要对患者进行长期随访.

Congenital vahular aortic stenosis （AS）,which refers to a congenital malformation of the aortic valve,is the most common causes of left ventricular outflow tract obstruction in chiidren.In 1983,percutaneous balloon aortic valvuloplasty （PBAV） was firstly described as the treatment for congenital AS in children.Over the past 30 years advancement in technique and equipment had radically improved the safety and outcome of balloon valvuloplasty of aortic valve.Nowadays the technique is widely regarded as the therapy of first choice for children with congenital AS.However,it is essential to make decisions about treatment and define which approach has the best chance of success for any given patient before the initial intervention,especially for the neonate with critical AS.PBAV is usually effective for acutely relieving left ventricular outflow obstruction and has excellent short term results in most childen with congenital AS.The mid-and long-trem outcome after a successful balloon dilation of congenital AS in childhood is also good,but late restenosis and valve regurgitation eventually necessitate reintervention in the majority of children,which included aortic valve replacement.PBAV was found to have a high incidence of complications and remains one of the most challenging procedures in the inttcventional therapy of congenital heart disease.Operators should not only acquire the necessary manual skills,but also have the ability to make sound clinical judgment and deal with critical events.Owing to its palliative nature of balloon dilation for congenital AS,the follow-up care of patients after procedure is quite important.