球囊肺动脉瓣成形术疗效的影响因素和术后心脏形态学的变化

Factors related to results of percutaneous balloon pulmonary valvuloplasty and long-term follow-up

目的 判明影响经皮球囊肺动脉瓣成形术 (PBPV)疗效的因素和术后心脏形态学的变化。方法 用逐步回归法对 138例患者术前和术后的跨瓣压差、球囊 瓣环比值、肺瓣口面积和球囊充盈时间进行分析 ;对术前和术后的右室腔直径、右室壁厚度和ECG的Rv1 行t检验 ;对术前、术后和随访所测量的跨瓣压差行单因素方差分析。结果 术前跨瓣压差 (13 5 5± 0 6 9)kPa ,术后压差 (4 5 1± 0 4 1)kPa ,下降百分比为 6 1 4 1%± 2 6 2 % (P <0 0 0 1) ;设术后残余压差 (A)为因变量 ,术前跨瓣压差 (X)、球囊 /瓣环比值 (Y)、肺瓣口面积 (Z)和球囊充盈时间 (W)为自变量 ,得回归方程为A =13 94 +0 3114X - 6 2 4 5 5Y - 0 775 1Z ,R2 =0 6 74 8;10 7例患者得到随访 ,随访时间为 89± 2 8(38～ 12 6 )个月 ,平均随访压差 (3 38± 0 4 7)kPa ,随访压差较前明显降低 (P <0 0 0 1) ;随访所测量的右室腔直径、右室壁厚度和ECG的Rv1 较治疗前有显著良性转归 (P均 <0 0 5 )。结论 先天性肺动脉瓣狭窄 (PVS)严重程度是影响PBPV疗效的关键因素 ,术后心脏形态学可以发生一定程度的好转 ,但大年龄患者的好转机会小于儿童。提示PVS一经确诊 ,即应行PBPV治疗。

Objective To discuss the factors that maybe related to the analysis of results of percutaneous balloon pulmonary valvuloplasty (PBPV) and the changes of cardiac morphology after PBPV. Methods Multiple linear regression was used to study peak gradient, balloon-anulus ratio (BAR), pulmonary orifice area and time of inflation before and after PBPV. One hundred and thirty-eight patients (age between 6 months and 28 years old, mean 8.34±0.81). T test was used to study the diameter and thickness of the right ventricle (RV), and Rv 1 of ECG before and during the follow-up. F test was used to determine peak gradient before and after PBPV and during the follow-up. Results There was a notable reduction in the peak to peak gradient from 13.55±0.69 kPa to 4.51±0.41 kPa (P<0.001). Data of clinical and Doppler follow-up for 89±28 (38 to 126) months after PBPV were obtained in 107 patients, revealing a further decrease in the gradient, 3.38±0.47 kPa (P<0.01). Much improvement was found in RV of diameter, and thickness and Rv 1 of EKG (P<0.05). Data were obtained from the regression equation: A=13.94+0.311?4 X-6.245?5 Y-0.775?1 Z (A for remnant gradient after PBPV; X for peak gradient before PBPV; Y for balloon-anulus ratio; Z for pulmonary orifice area.), R2=0.674?8. Conclusion The degree of pulmonary valve stenosis (PVS) is the key factor influencing the result of PBPV. Although the results of PBPV obtained during the follow-up are good on the whole, more satistactory findings in morphology after PBPV have been achieved in low-age children than in older patients.