房间隔缺损合并肺动脉瓣狭窄患者同期行介入治疗的疗效评价

Concurrent percutaneous atrial septal defect closure and pulmonary valvuloplasty

目的 :初步评价房间隔缺损合并肺动脉瓣狭窄同期行介入治疗的疗效 .方法 :8例患者 ,年龄 3～ 37(1 3± 1 5 )岁 ,经临床及超声心动图确诊为房间隔缺损合并肺动脉瓣狭窄 .术前行彩色多普勒超声心动图检查 ,术中均行右室造影证实诊断 .首先在透视下经皮球囊肺动脉瓣成形术 (PBPV)治疗肺动脉瓣狭窄 (PS) ,术后即时右心导管观察右心室压力和跨肺动脉瓣压力压差变化 ;然后在食管超声心动图或经胸超声心动图监视下经导管置入Amplatzer伞封堵房间隔缺损 ,术后即时行超声心动图 ,术后 2 4h ,1mo ,3mo和 6mo分别行经胸超声心动图评价房间隔缺损治疗效果 .结果 :8例患者疗效均佳 ,PBPV术后即刻右室收缩压由 (1 1 .5 7± 4 .0 9)kPa降至 (5 .4 9± 2 .0 9)kPa (P <0 .0 0 1 ) ,肺动脉至右心室跨瓣压差由 (7.5 7± 4 .4 9)kPa降至 (1 .89± 1 .6 3)kPa (P <0 .0 0 1 ) .房间隔未见残余分流 .结论 :房间隔缺损合并肺动脉瓣狭窄同期行介入治疗疗效可靠 。

AIM: To evaluate the effectiveness and short term results of combined percutaneous ballon pulmonary valvuloplasty (PBPV) and atrial septal defect closure for pulmonary valvular stenosis (PS) associated with seccundum atrial septal defect (ASD) . METHODS: Eight patients, 3～37 (13±15)years old, were confirmed with ASD in association with PS by transthoracic echocardiography (TTE). Percutaneous balloon pulmonary valvuloplasty (PBPV) was done initially; ASD was closed later using Amplatzer occluder device under guidance of fluoroscopy and transesophageal echocardiography (TEE)or TTE, TTE were performed immediately and 24 h, 1 mo, 3 mo and 6 mo after occlusion to evaluate the efficiency. RESULTS: The procedure was successful in all 8 patients. Right ventricular systolic pressure significantly decreased from (11.57± 4.09) kPa to [5.49±2.09 kPa ( P <0.001)]. The transpulmonary valve systolic gradient significantly decreased from (7.57±4.49) kPa to [1.89±1.63 kPa ( P <0.001)] immediately after PBPV; No residual shunt of atrial septal was found in 8 patients immediately after the procedure and in the follow up. CONCLUSION: Simultaneous PBPV and closure of the ASD appears to be an effective and safe modality for PS associated with ASD .It should be an alternative to surgery.