经皮球囊肺动脉瓣成形术治疗儿童肺动脉瓣狭窄合并

Clinical analysis of percutaneous balloon pulmonary valvuloplasty for pulmonary stenosis complicated with subravalvular pulmonary stenosis and supravalvular pulmonary stenosis in children

摘要:

目的：评估经皮球囊肺动脉瓣成形术（percutaneous balloon pulmonary valvuloplasty，PBPV）治疗先天性肺动脉瓣狭窄（pulmonary stenosis，PS）合并先天性肺动脉瓣下狭窄（轻度）和肺动脉瓣上狭窄的临床疗效。方法：总结近10年经临床、心电图、胸片、超声心动图证实为肺动脉瓣狭窄合并瓣下狭窄（轻度）和瓣上狭窄共45例。行瓣膜扩张术前先确定瓣环大小、瓣口面积、跨肺动脉瓣压差。球囊直径选择比瓣环直径大20％～40％，扩张后即刻测肺动脉-右心室的跨瓣压差（△P），观察比较PBPV术后肺动脉瓣的开放、心电图及肺动脉瓣、三尖瓣的返流情况。结果：45例肺动脉瓣狭窄合并肺动脉瓣下狭窄（轻度）或瓣上狭窄患儿中，42例扩张成功，成功率为93.333％。在肺动脉瓣狭窄合并肺动脉瓣下狭窄（轻度）病例组及肺动脉瓣狭窄合并肺动脉瓣上狭窄病例组中，术前、术后跨肺动脉瓣压差均有统计学意义（P＜0.05）。在肺动脉瓣狭窄合并瓣下狭窄（轻度）或瓣上狭窄病例组中，对于瓣环发育良好和轻中度肺动脉瓣环发育不良的患儿，术前、术后跨肺动脉瓣压差均有统计学意义（P＜0.05）。结论：当右室流出道血流速度小于3.810 m/s时，PBPV术是治疗肺动脉瓣狭窄合并肺动脉瓣下（轻度）狭窄有效方法。对于肺动脉瓣狭窄合并肺动脉瓣上狭窄的患儿（肺动脉瓣上狭窄内径大于5 mm），PBPV术是比较安全、有效的方法。在肺动脉瓣狭窄合并瓣下狭窄（轻度）或瓣上狭窄病例组中，对于瓣环发育良好和轻中度肺动脉瓣环发育不良的患儿，PBPV术治疗效果较好。

Abstract:

Objective：To evaluate the clinical efficacy of percutaneous balloon pulmonary valvuloplasty（PBPV） for pulmonary stenosis（PS） complicated with subvalvular pulmonary stenosis（mild） and supravalvular pulmonary stenosis. Methods：A total of 45 patients of pulmonary stenosis complicated with subvalvular pulmonary stenosis（mild） and supravalvular pulmonary stenosis，who encountered in author’s hospital during past 10 years，were enrolled in this study. The diagnosis was conformed by clinical manifestations，electro－cardiograph（ECG），X-ray，echocardiography. The valve ring size，valvular area，pulmonary valve differential pressure were confirmed before the PBPV. The balloon with the diameter（20％-40％） bigger than the valve ring was confirmed. After the PBPV，the PA-RV （pulmonary artery-right ventricle） pressure was measured immediately. The pulmonary valve open，ECG，pulmonary valve and tricus－pid valve regurgitation were checked. Results：Among 45 cases of pulmonary stenosis complicated with subvalvular pulmonary stenosis （mild） and supravalvular pulmonary stenosis，42 cases had successful intervention，with the success rate of 93.333％. In the pul－monary stenosis complicated with subvalvular pulmonary stenosis（mild） and supravalvular pulmonary stenosis group，preoperative and postoperative pulmonary transvalvular pressure gradient was statistically significant（P＜0.05）. In pulmonary stenosis complicated with subvalvular pulmonary stenosis（mild） and supravalvular pulmonary stenosis，preoperative and postoperative pulmonary transvalvular pressure gradient was statistically significant（P＜0.05）. Conclusion：When the blood flow velocity of right ventricular outflow tract is less than 3.810 m/s，PBPV is the effective treatment for subvalvular pulmonary stenosis（mild）. PBPV is safe and effective for pulmonary stenosis complicated with supravalvular pulmonary stenosis（the diameter of supravalvular pulmonary stenosis is larger than 5 mm）. In pulmonary stenosis complicated with subvalvular pulmonary stenosis （mild） and supravalvular pulmonary stenosis，PBPV is effective when the pulmonary valve ring is well developed or mild-to-moderate maldeveloped.