经皮球囊肺动脉瓣成形术治疗成年肺动脉瓣狭窄患者疗效观察及年龄对预后影响

Effect of percutaneous balloon pulmonary valvuloplasty on the treatment of adult patients with pulmonary stenosis and the impact of age on the prognosis

目的观察经皮球囊肺动脉瓣成形术治疗成年肺动脉瓣狭窄患者的疗效,并分析年龄对预后的影响。方法选取北部战区总医院自2016年8月至2019年6月收治的43例单纯肺动脉瓣狭窄成年患者为研究对象,所有患者均在接受入院常规检查及心电图、心脏正侧位X线、经胸超声心动图检查确诊后接受经皮球囊肺动脉瓣成形术。根据年龄,将患者分入青壮年组(年龄18~44岁,n=20)和中老年组(年龄>44岁,n=23)。所有患者均于术前、术后1 d及术后1、3、6个月行心电图检查和经胸超声心动图检查,记录患者的跨肺动脉瓣压差、过肺动脉瓣最大血流速度、右房左右径、右房前后径、右室内径、室间隔厚度、右室/左室内径比值等。结果经皮球囊肺动脉瓣成形术成功率为100.0%(43/43)。与术前比较,术后各时间点过肺动脉瓣最大血流速度、跨肺动脉瓣压差均明显下降,差异有统计学意义(P<0.05);但术后各时间点过肺动脉瓣最大血流速度、跨肺动脉瓣压差比较,差异均无统计学意义(P>0.05)。与术前比较,术后各时间点右房左右径、右房前后径均明显下降,差异有统计学意义(P<0.05);术后各时间点右室内径、室间隔厚度、右室/左室内径比值与术前比较,差异均无统计学意义(P>0.05)。与术前比较,青壮年组和中老年组患者术后右房左右径、右房前后径、跨肺动脉瓣压差均明显下降,差异有统计学意义(P<0.05);两组患者术后右房左右径、右房前后径、跨肺动脉瓣压差比较,差异均无统计学意义(P>0.05)。青壮年组患者术后1、3、6个月时的右室内径均明显小于中老年组,差异有统计学意义(P<0.05)。结论经皮球囊肺动脉瓣成形术治疗成年肺动脉瓣狭窄的近中期疗效良好,青壮年和中老年患者的右房均可显著重构逆转,青壮年患者的右室重构逆转能力明显优于中老年患者。

Objective To observe the efficacy of percutaneous balloon pulmonary valvuloplasty(PBPV)in the treatment of adult patients with pulmonary stenosis(PVS)and to analyze the impact of age on the prognosis.Methods A retrospective study was performed on 43 cases of adult patients with PVS who were admitted from August 2016 to June 2019.All patients underwent PBPV after being confirmed by routine examination at admission,electrocardiogram(ecg),frontal and lateral cardiac X-ray and echocardiography.According to age,patients were divided into the young and middle-aged group(aged 18-44 years old,n=20)and the middle and elderly group(aged more than 44 years old,n=23).All the patients underwent ecg and transthoracic echocardiography(TTE)before and 1 day after the surgery and 1,3 and 6 months after the surgery to record the transvalvular pressure gradient(TPG),the maximum flow velocity across the pulmonary valve,the left and right atrium diameter,the anterior and posterior diameter of the right ventricle,the ventricular septum thickness and the ratio of the right ventricle/left diameter.Results The success rate of PBPV was 100.0%(43/43).Compared with the preoperative results,the maximum flow velocity and the TPG reduced significantly at each time point after the surgery(P<0.05).However,there was no statistically significant difference between the maximum flow velocity and the TPG at each time point after the surgery(P>0.05).Compared with that before surgery,the right atrial diameter at each time point after surgery,the right atrial diameter before and after the surgery were significantly reduced,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the ratio of right ventricular diameter,interventricular septum thickness and right ventricular/left ventricular diameter(P>0.05).At 1,3 and 6 months after surgery,the right ventricular diameter of the young and middle-aged group was significantly smaller than that of the middle and elderly group(P<0.05).Conclusion Percutaneous balloon pulmonary valvuloplasty has a good effect in the near and medium term in the treatment of adult pulmonary stenosis,and the right atrium can be significantly remodeling and reversed in both young and middle-aged patients,and the right ventricle remodeling and reversal ability in young and middle-aged patients is obviously superior to that in middle-aged and elderly patients.