经皮球囊肺动脉瓣成形术介入治疗肺动脉瓣狭窄疗效评价

The Effect of Percutaneous Balloon Pulmonary Valvuloplasty for Pulmonary Valve Stenosis in Infants and Neonates

目的：探讨经皮球囊肺动脉瓣成形术（PBPV）治疗小婴儿和新生儿肺动脉瓣狭窄的疗效。方法：选取2013年10月至2014年10月接受PBPV的患儿12例,年龄6～169（106±46）d,体质量4.5～8.6（6.7±1.3）kg。首先右心导管分别测量患儿右心房、右心室及肺动脉压力,危重小婴儿先用小球囊预扩张肺动脉瓣,然后用单球囊法扩张肺动脉瓣,球囊径/瓣环径比值为（1.0±0.1）。术后采用超声心动图评价疗效。结果：所有患儿均成功实施PBPV,平均右室收缩压由术前（110±28）mm Hg下降至术后的（53±16）mm Hg（P〈0.01）,跨肺动脉瓣压力阶差由术前（84±26）mm Hg下降至术后的（25±13）mm Hg（P〈0.01）。无严重并发症及死亡病例发生,随访1～12个月,患儿跨肺动脉瓣压力阶差基本保持稳定,术后1个月为（24±13）mm Hg,仅1例残余肺动脉瓣狭窄,无明显肺动脉瓣反流。结论：PBPV在小婴儿和新生儿重度肺动脉瓣狭窄中应用安全可行,选择合适大小球囊是介入治疗成功的重要环节。

Objective： To evaluate the effect and safety of percutaneous balloon pulmonary valvuloplasty （PBPV） in infants with pulmonary valve stenosis （PVS）. Methods： From October 2013 to October 2014, 12 children with PVS underwent percutaneous balloon pulmonary valvuloplasty. The median age and body weight were 6 ～ 169 （106±46） days and 4.5 ～ 8.6 （ 6.7 ± 1.3 ） kg. The right cardiac catheterization was used to measure the right atrium and right ventricle pressure and the pulmonary artery pressure. In neonates with critical pulmonary stenosis, valve should be pre-dilated using a low-profile balloon, then single balloon kyphoplasty was used to dilate pulmonary artery valve, the mean ratio of the balloon to annulu was （1.0±0.1）, and the postoperative therapeutic effect was evaluated by echocardiography. Results： All children underwent PBPV were successful. Right ventricular systolic pressure was decreased [ from （110±28） mm Hg to （53±16） mm Hg, P〈0.01 ], the mean pressure gradient of pulmonary valve was decreased [ from（ 84±26 ）mm Hg to （25 ± 13 ） mm Hg, P〈0.01 ]. There were no serious complications and death during PBPV. During a follow-up of 1 to 12 months, the mean pressure gradient of pulmonary valve remained stable, （24±13） mm Hg after PBPV 1 month with only one children remained residual pulmonary stenosis. No significant pulmonary regurgitation was seen. Conclusion： Percutaneous balloon pulmonary valvuloplasty for severe pulmonary valve stenosis in infants and neonates is relatively safe and effect, that appropriate size of balloon is important in the treatment.