Rao P S, Wilson A D, Chopra P S
Departments of Pediatrics and Surgery, University of Wisconsin Medical School, Madison.
J Invasive Cardiol. 1990 Mar-Apr;2(2):65-71.
Six children with subvalvar aortic stenosis underwent percutaneous balloon angioplasty over a 15-month-period ending October 1989. The mean systolic pressure gradient across the left ventricular outflow tract decreased from 56 +/- 19 (mean +/- SD) to 12 +/- 7 mmHg (p less than 0.001) immediately following valvuloplasty and the degree of aortic insufficiency did not significantly increase. Follow-up Doppler data (in all 6 patients) were available 3 to 16 months (mean, 11 months) after angioplasty and revealed a residual aortic subvalvar gradient of 21 +/- 5 mmHg, which continues to be significantly lower (p less than 0.001) than that prior to angioplasty. There was no increase in aortic insufficiency. The single infant with increase in gradient at followup was determined to have fibromuscular, tunnel type of subaortic obstruction. None of the five patients with discrete membranous obstruction had significantly increased their gradients. Use of balloons larger than aortic valve anulus did not produce any adverse effect, particularly aortic insufficiency. We surmise that the immediate and intermediate-term follow-up results of balloon angioplasty are encouraging and balloon angioplasty should be considered as a treatment option in the initial management of discrete subaortic membranous stenosis.
在截至1989年10月的15个月期间，6名患有主动脉瓣下狭窄的儿童接受了经皮球囊血管成形术。瓣膜成形术后，左心室流出道的平均收缩压梯度立即从56±19（平均值±标准差）降至12±7 mmHg（p<0.001），且主动脉瓣关闭不全程度未显著增加。血管成形术后3至16个月（平均11个月）可获得所有6名患者的随访多普勒数据，结果显示残余主动脉瓣下梯度为21±5 mmHg，仍显著低于血管成形术前（p<0.001）。主动脉瓣关闭不全未加重。随访时梯度增加的那例婴儿被确定为纤维肌性、隧道型主动脉瓣下梗阻。5例离散膜性梗阻患者中，无一例梯度显著增加。使用大于主动脉瓣环的球囊未产生任何不良影响，尤其是未导致主动脉瓣关闭不全。我们推测，球囊血管成形术的近期和中期随访结果令人鼓舞，在离散性主动脉瓣下膜性狭窄的初始治疗中，应将球囊血管成形术视为一种治疗选择。
