婴儿肺动脉瓣狭窄的介入治疗

Transcatheter interventional therapy for pulmonary stenosis in infants

目的总结经皮球囊肺动脉瓣成形术(PBPV)治疗婴儿肺动脉瓣狭窄(PS)的经验,评价其必要性、安全性和有效性。方法回顾性分析2009年1月至2018年12月青岛市妇女儿童医院心脏中心行PBPV治疗68例婴儿PS的临床资料。结果患儿平均手术年龄为(6.34±3.6)个月,平均手术体重为(7.81±2.11)kg,术前体重/年龄Z值为-0.80±1.38,提示生长受限为22例(32.4%),合并紫绀15例(22.1%),呼吸急促23例(33.8%)。超声心动图评估右室长径/左室长径比值平均值为0.56±0.73,胸部正位片心胸比平均值为0.56±0.43,术前血氧饱和度平均值为94.74%±6.10%。术前右室/左室收缩压力比值平均值为0.68±0.26。球囊扩张后,肺动脉瓣平均压力梯度由(75.57±18.61)mmHg降至(22.37±5.21)mmHg,右心室收缩压平均值由(83.78±22.44)mmHg降至(54.16±20.81)mmHg。手术即刻成功率为100%。术中无严重心律失常、心腔穿孔、腱索断裂、血管损伤等并发症。术后早期患儿轻-中度肺动脉瓣反流比例为53.3%,无重度反流。随访3个月~10年间再狭窄率2.94%,32例随访5年以上患儿肺动脉瓣反流程度未进一步加重,无特殊处理。所有患者均未出现明显的右心室功能障碍。与接受PBPV治疗幼儿PS相比,婴儿PS临床症状明显,病情较重,术后早期及中远期随访手术效果满意。对本研究婴儿PS进行分组比较分析发现低体重、低龄儿可获得同样良好手术效果。结论PBPV治疗婴儿肺动脉瓣狭窄十分必要,技术操作安全可行,随访结果持续有效。

Objective To summarize the experience of percutaneous balloon pulmonary valvuloplasty for pulmonary stenosis in infants,and to evaluate its necessity,safety and effectiveness.Methods From January 2009 to December 2018,68 cases of pulmonary stenosis were treated by percutaneous balloon pulmonary valvuloplasty.The clinical data before and after operation were analyzed retrospectively.Results The mean age was(6.34±3.6)months.The mean operation weight was(7.81±2.11)kg.The preoperative body weight/age Z score was -0.80±1.38,and growth restriction was in 22 cases(32.4%),cyanosis in 15 cases(22.1%)and tachypnea in 23 cases(33.8%).The mean right ventricular/ left ventricular length-diameter ratio was 0.56±0.73 by echocardiography,the mean cardiothoracic ratio was 0.56±0.43 by chest radiography,and the average value of preoperative oxygen saturation was 94.74 ± 6.10.The mean systolic pressure ratio of right ventricle/left ventricle before operation was 0.68±0.26.After balloon dilation,the mean pressure gradient of pulmonary valve decreased from(75.57±18.61)mmHg to(22.37±5.21)mmHg,and the mean systolic pressure of right ventricle decreased from(83.78±22.44)mmHg to(54.16±20.81)mmHg.The immediate success rate of operation was 100%.There were no serious arrhythmia,cardiac perforation,rupture of tendon chordae,vascular injury or other complications during the operation.The proportion of mild to moderate pulmonary regurgitation was 53.3% in early stage after operation,and there was no severe regurgitation.The restenosis rate was 2.94% during the follow-up period of 3 months to 10 years.The pulmonary valve regurgitation degree of 32 children who were followed up for more than 5 years did not further aggravate,and no specific management was carried out.No obvious right ventricular dysfunction was found in all patients.Compared with the toddlerhood infants undergoing PBPV in our center,the babyhood infants had obvious clinical symptoms and serious condition.The early and medium- long- term follow-up after operation was satisfactory.There was no significant difference in the effect of operation in the low-weight or low-age infants in babyhood.Conclusion PBPV is necessary for the treatment of pulmonary stenosis in infants.The technique is safe and feasible,and the follow-up results are effective.