经皮肺动脉瓣球囊扩张术临床应用30年疗效分析

Long-term outcome of percutaneous balloon pulmonary valvuloplasty in the treatment of pulmonary valve stenosis for 30 years

目的分析总结经皮肺动脉瓣球囊扩张术(PBPV)单中心临床应用30年治疗肺动脉瓣狭窄的临床价值及疗效。方法 1986年4月至2016年4月阜外医院共完成1229例PBPV,对其中临床资料完整的655例患者进行了6个月及以上的有效随访,随访时间为0.5～11.5年,平均(2.6±1.3)年,主要随访包括电话随访及门诊随访(以复查超声心动图为主)。结果 1229例患者术后即刻导管测量的跨瓣压差(PG)由术前(74.40±29.64)mmHg下降至(25.05±8.62)mmHg,下降明显(P<0.001),最后1次随访时超声心动图测量的平均PG维持在(21.91±17.22)mm Hg。PBPV成功率达到98.5%(1211/1229),发生术中及围术期死亡3例(死亡率0.2%),其他严重并发症(包括三尖瓣腱索断裂、肺动脉瓣重度反流)发生率为0.4%(5/1229)。超声心动图随访中3.1%(20/655)肺动脉瓣反流程度较术后24 h有所增加,再狭窄发生率为1.1%(7/655)。结论 30年的临床应用经验表明PBPV作为一种主要治疗单纯性肺动脉瓣狭窄的介入技术,其总体近、中、远期疗效满意,并发症发生率低,可作为一项瓣膜病微创治疗时代的主流技术继续应用于临床。

Objective To evaluate the clinical application of percutaneous balloon pulmonary valvuloplasty(PBPV)in the treatment of pulmonary valve stenosis(PS)for 30 years in a single center.Methods Since April 1986 to April 2016,a total of 1229 PBPVs were performed in Fuwai Hospital,among whom,655 patients with complete clinical data were followed up for more than 6 months.The average follow-up time was(2.6±1.3)years(0.5 to 11.5 years),the main follow-up measures include telephone follow-up and outpatient follow-up(echocardiographic assessment).Results The pressure gradient(PG)measured by catheterization in 1229 patients significantly decreased from(74.40±29.64)mmHg before the procedure to(25.05±8.62)mmHg immediately after the procedure,with an obvious dropping(P<0.05).During the subsequent follow-up,the last PG measured by ultrasound was maintained at(21.91±17.22)mmHg on average.If the technical success criteria are PG<35 mmHg immediately after PBPV or a drop of more than 60%of PG,the technical success rate reaches 98.5%(1211/1229).There were 3 intraoperative and perioperative deaths(a mortality rate of 0.24%),and the incidence of other serious complications(including tricuspid valve rupture and more than moderate pulmonary regurgitation)was 0.4%(5/1229).At the time of echocardiographic follow-up,20 patients(3.0%)had an 1 degree increase in pulmonary valve regurgitation compared with 24 hours after operation.The incidence of restenosis was 0.5%(7/655)during follow-up.Conclusions Thirty years of clinical experience have shown that the PBPV as a main treatment for pulmonary stenosis has a satisfactory short,medium and long-term results,and the complication rates are low.Therefore,it can be considered as a mainstream technology in the era of interventional therapy for valvular diseases.An increase of the pulmonary regurgitation in a small number of patients during the follow-up requires further clinical investigation.