肺动脉瓣狭窄DSA检查治疗及彩色超声联合应用效果观察

目的随着世界人口增长,先天性心脏病作成为了危害人类健康的主要疾病^([1])。在介入治疗问世之前,先天性心脏病主要通过外科手术治疗,但手术创伤、麻醉、体外循环等一系列围术期难题始终困扰人类。随着介入治疗的兴起,人们找到了以微创方式代替很多外科创伤性较大的手术并且可达到内科希望根治的目的 ^([2,3])。但由于介入治疗发展至今,治疗方式、器械的选择及治疗后的近期及中远期疗效等诸多问题仍未得到定论,迫切需要解决^([4,5])。因此,此研究课题对一种常见先心病-肺动脉瓣狭窄(PS)的介入治疗效果进行观察并在介入术前后采用超声心动图对患者进行检查,其结果用以评价彩色超声在肺动脉瓣狭窄DSA检查治疗联合应用中所起到的作用。方法此研究对90例符合条件的肺动脉瓣狭窄患者进行介入治疗,于术前、术后1天、1个月、6个月、1年的时间节点分别对患者进行超声心动图检查,进行疗效观察。结果 (1)PBPV术后患者即刻压差下降率大于60%,平均跨瓣压差在治疗后中期(术后6个月-1年)、远期(术后1-5年)随访中无明显变化。(3)彩色超声多普勒用于轻中度PS患者检查跨肺动脉瓣压力时,其检查结果与导管法测量结果无显著差异,且两者存在相关性(r=0.75和0.67,P<0.05);而彩色多普勒超声用于重度PS患者时,其测得的跨瓣压明显高于导管法测量值,两者差异性显著,且无明显相关性(r=0.59,P>0.05)。

Objective To explore the effect of interventional treatment,with patients who had pulmonary valve stenosis(PS) with different order of severity.To explore the contribution of echocardiography in interventional treatment.To observe the geometric changes of heart after interventional therapy.Methods 90 patients(aged 23.2±7.1 years) with PS were included in the study.They received the way of interventional therapy named PBPV.Peak systolic pressure gradient from the right ventricle to the pulmonary artery before and immediately after PBPV was measured by catheterization.Doppler estimated the transvalvular pressure gradients before.24hours、1month、3month、6month、1year and5 years after PBPV.Pulmonary artery regurgitation was observed by echocardiography.Results The successfully rate was 100%in PS.The pressure gradients from the right ventricle to the pulmonary artery decreasrd continoualy after PBPV in all patients.NO restenosis secured after PBPV,The measurement was no different between echocardiography and catheterization to measure the peak systolic pressure gradient in patients of mild stenosis and moderate stenosis,but the measurement by catheterization was better than that by echocardiography in patients of sever stenosis.