经皮球囊肺动脉瓣成形术治疗先天性肺动脉瓣狭窄即刻和远期疗效

Immediate and long-term therapeutic efficacy of percutaneous balloon pulmonary valvuloplasty in the treatment for congenital pulmonary stenosis

【目的】评价经皮球囊肺动脉瓣成形术(percutaneous balloon pulmonary valvuloplasty,PBPV)治疗肺动脉瓣狭窄(pulmonary valve stenosis,PS)的即刻和远期的疗效。【方法】选择自2002年6月至2015年10月,实施PBPV的243例先天性PS患者。男111例,女132例,年龄2个月~77岁,均为单纯性PS患者,跨肺动脉瓣压力阶差(pulmonary transvalvular gradient,PTG)≥40mm Hg(1 mm Hg=0.1333 k Pa),不伴有明显的肺动脉瓣发育不良和其它心血管畸形。根据PBPV术前心导管所测右心室压力将患者分为轻、中、重度3组。行右心室正侧位造影,测量肺动脉瓣瓣环直径,选择合适球囊,采用单球囊扩张。扩张术后根据PTG将疗效分为优、良、差:PTG≤25 mm Hg为优,25~50 mm Hg为良,大于50 mm Hg为差。术后1、3、6个月随访,到2015年10月平均随访(7.53±2.03)年,随访内容包括临床症状和体格检查,心电图和超声心动图检测。【结果】轻、中、重度三组的术后PTG和术前比较明显下降(P<0.01),三者间疗效不同(P<0.01)。对术前跨瓣压差、球囊/瓣环比值、术前肺动脉瓣环直径和年龄行多元回归分析显示,确定系数R2=0.301,术前跨瓣压差(标化系数为0.550)、术前瓣环直径(标化系数为0.146)、球囊/瓣环比值(标化系数为0.103)对疗效有显著的影响,年龄对疗效无明显影响。【结论】PBPV治疗PS即刻及中远期疗效满意,严重并发症少,能够作为先天性PS的首选治疗方法。术前PS的程度对疗效有明显影响,少数狭窄程度较重的患者,PBPV术后疗效越差。

【Objective】To evaluate the immediate and long-term therapeutic efficacy of percutaneous balloon pulmonary valvuloplasty（PBPV）in the treatment for pulmonary stenosis（PS）.【Methods】A total of 243 patients（111 males and 132 females） with congenital PS undergoing PBPV were chosen from June 2002 to October 2015, whose age ranged from 2 months to 77 years and was averagely 12.9 years. They all suffered simple PS, whose pulmonary transvalvular gradient（PTG） was equal to or greater than 40 mm Hg. These patients were excluded from distinct pulmonary valve dysplasia and other cardiovascular malformation. According to the right ventricular pressure detected with cardiac catheter before PBPV, the patients were divided into mild, moderate and severe groups. The diameter of pulmonary valve ring was measured under right-ventricular frontal and lateral radiography. Suitable balloon was chosen and single balloon was used for the dilatation. According to the postoperative PTG, the therapeutic efficacy was classified in 3 groups： it was ＂excellent＂ when PTG was equal to or less than 25 mm Hg;it was ＂good＂ when PTG was from 25 to 50 mm Hg; it was ＂poor＂ when PTG was more than 50 mm Hg. Every patient who underwent successful PBPV was followed up clinically after 1, 3 and 6 months of the operation. By October 2015, the average follow-up time was（7.53±2.03） years.The follow-up content included clinlcal symptoms, ECG and echocardiogram.【Results】The postoperative PTG in the mild, moderate and severe groups were significantly lower than the preoperative PTG in these group（P〈0.01）. The therapeutic efficacy was different among the three groups（P〈0.01）. Multiple regression analysis of preoperative PTG, balloon/annulus diameter ratio, preoperative diameter of pulmonary valve ring and age showed that; the coefficient of determination R2 was equal to 0.301; preoperative PTG（standardized coefficient was 0.550）,preoperative diameter of pulmonary valve ring（standardized coefficient was 0.146） and preoperative balloon/annulus diameter ratio（standardized coefficient was 0.103） were positively associated with the therapeutic efficacy; the age had no significant effect on it.【Conclusion】The immediate and long-term therapeutic efficacy of PBPV is satisfactory.It has less severe complications and can be a preferred treatment for congenital PS. The degree of preoperative PS has a significant effect on curative efficacy. It is worse in a small number of patients with severe stenosis.