球囊成形术治疗婴幼儿重度肺动脉瓣狭窄临床效果

摘要

Objective To evaluate the effect and safety of percutaneous balloon pulmonary valvuloplasty ( PBPV) in inf'ants and toddlers with severe congenital pulmonary valve stenosis ( PVS) . Methods From September 2001 to June 2010, 44 patients less than 36 months old with severe PVS underwent PBPV. The patients were divided into infant group (n = 18) , toddler group 1 (n = 13) , toddler group 2 (n = 13) . The treatment outcomes and complications were compared between three groups. Results All patients underwent PBPV successfully. After PBPV, both of right ventricular peak systolic pressure ( RVSP) and systolic. trans-pulmonary pressure gradient (TPG) were significantly decreased. There were no senous complications and death during PBPV. Thirteen ( 29.5％) patients had pulmonary regurgitation and 5 (11.4％) patients had tricuspid regurgitation. Compared with toddlers, RVSP, pulmonary artery systolic pressure. and TPG after PBPV were similar in inf'ants (all P ＞ 0.05) . Long term follow-up revealed that. TPG remained stable with only one patient having TPG increased again. Conclusion BPPV as a treatment of PVS in infant and todddler's PVS is safe and reliable. It can effectively relieve pulmonary stenosis. There are no difference in efficacy and safety between infants and toddlers.%目的 探讨经皮球囊肺动脉瓣成形术(PBPV)治疗婴幼儿重度肺动脉瓣狭窄(PVS)的效果和安全性.方法 自2001年9月至2010年6月,共对44例2 ～ 35个月的重度PVS患儿进行PBPV治疗,并按年龄分为婴儿组( ＜ 12个月,n ＝ 18)、幼儿一组(12 ～ 23个月,n ＝ 13)、幼儿二组(24 ～ 35个月,n ＝ 13)比较不同年龄组患儿PBPV的治疗效果和并发症.结果所有患儿均成功实施PBPV,术后右心室压力和跨肺动脉瓣压力阶差显著下降,无死亡和严重并发症发生.术后出现肺动脉瓣关闭不全13例(29.5%),三尖瓣关闭不全5例(11.4%).婴儿组术前右心室收缩后和术后右心室收缩后、术后肺动脉收缩压、术后跨肺动脉瓣压力阶差与幼儿一组、二组比较差别无统计学意义(P均＞ 0.05).随访显示,患儿跨肺动脉瓣压力阶差基本保持稳定,仅1例患儿再次升高.结论 PBPV治疗重度婴幼儿PVS安全可靠,能有效解除肺动脉瓣狭窄.与幼儿一组、二组比较,婴儿PBPV在疗效和安全性方面差别无统计学意义.