经皮球囊肺动脉瓣成型术治疗肺动脉瓣狭窄86例临床分析

Follow-up of 86 patients underwent percutaneous balloon pulmonary valvuloplasty

目的 评价经皮球囊肺动脉瓣成形术 (PBPV)治疗肺动脉瓣狭窄 (PS)的近期和远期疗效及安全性。方法 总结近 10年行PBPV术 86例患者术后即刻、术后 3天、术后 3个月、术后 1年的心电图、心脏彩超等检查结果 ,观察PBPV的安全可靠性 ,并与同期外科手术的疗效比较。结果 PBPV术后即刻右心室收缩压由 ( 98± 2 8)mmHg降至 ( 5 6± 19)mmHg(P <0 .0 1) ,肺动脉与右心室跨瓣压差 (ΔP)由 ( 64± 2 7)mmHg降至 ( 3 4± 11)mmHg(P <0 .0 1) ;心电图Tv1 由直立变为倒置 2 6例 ( 3 0 %)。术后 3天、3个月及 1年经超声测定ΔP分别为 ( 2 1± 9)mmHg、( 13± 7)mmHg、( 10± 5 )mmHg ;心电图Tv1 变为倒置例数分别为 64例、84例和 85例 ,与同期外科手术疗效比较差异无显著性。结论 PBPV术后即刻右心室压力可明显下降 ,若病例选择适当 ,几乎可以代替外科手术。PBPV操作简便 ,疗效可靠 。

Objective To evaluate the security,long term and recent effectiveness of percutaneous balloon pulmonary valvuloplasty(PBPV)for pulmonary valve stenosis(PS).Methods The security and reliability of the PBPV were investigated according to the electrocardiogram(ECG)and echocardigraphy in 86 patients with PS in 10 years,whose examinations were taken immediately,3 days,3 months,one year after the PBPV.The effect of PBPV was compared with the operation group.Results The right ventricle systolic pressure decreased from (98±28)mm Hg to (56±19)mm Hg( P <0.01)and systolic pressure gradient across the pulmonary valve decreased from (64±27)mm Hg to (34±11)mm Hg( P < 0.01) immediately after PBPV;Tv 1 became upside down in 26 patients(30%).The systolic pressure gradient across the right pulmonary valve 3 days,3 months and 1 year after PBPV were (21±9)mm Hg,(13±7)mm Hg and (10±5)mm Hg,respectively.The cases with upside down ECG were 64,84 and 85 respectively.Conclusion The right ventricle systolic pressure decreased significantly after PBPV.PBPV can take the place of the surgical operations for the appropriate cases with PS.It is the first choice for PS due to its convenient operation and reliable effect.