Massoud I, Imam A, Mabrouk A, Boutros N, Kassem A, Daouod A, El Hakem M A
Department of Pediatric Cardiology, National Heart Institute, Imbaba, Giza, Egypt.
Cardiol Young. 1999 Jan;9(1):24-36. doi: 10.1017/s1047951100007344.
Balloon dilation of the pulmonary valve was performed in 54 patients with tetralogy of Fallot with severe cyanosis, high haematocrit and severe valvar pulmonary stenosis. Clinical, echocardiographic, angiographic, and haemodynamic data were analyzed before and after the procedure. After balloon dilation, the systemic oxygen saturation increased from a mean value of 66% to 85%. The mean value of the haematocrit before dilation was 55 + 13, and decreased to 47 after dilation (p < 0.002) in 2 months follow-up. Balloon dilation increased the size of the pulmonary valvar orifice from a mean value of 9 + 5 mm to 11.5 + 2 mm (p < 0.005). The mean Z score of the pulmonary valves, which was -3 + 1.3 before dilation, increased to -1.1 + 1.1 immediately after the procedure (p < 0.05). The size of the right and left pulmonary arteries increased after dilation from 9 mm to 10 mm, and from 8.7 + 2.4 mm to 9.8 + 2.3 mm, respectively (p < 0.05). The comparable mean Z scores increased from -2.8 + 1.9 SD to -1.8 + 1.4 SD, and from -2.4 + 1.9 SD to -1.5 + 1.6 SD for the right and left branches, respectively (p < 0.05). In patients with stenosis at the bifurcation of the pulmonary trunk and hypoplasia of the left artery, successful dilation of the pulmonary valve lead to an increase of flow and improvement in size of the hypoplastic segment. In conclusion, initial balloon dilation of the pulmonary valve in tetralogy of Fallot resulted in increase of the Z score for the pulmonary valve and improved antegrade pulmonary blood flow, inducing growth of the pulmonary arteries and ameliorating the anatomic and physiologic preoperative condition.
对54例患有法洛四联症、严重紫绀、高血细胞比容和严重肺动脉瓣狭窄的患者进行了肺动脉瓣球囊扩张术。对手术前后的临床、超声心动图、血管造影和血流动力学数据进行了分析。球囊扩张术后，全身氧饱和度从平均66%升至85%。扩张前血细胞比容的平均值为55 + 13，在2个月的随访中，扩张后降至47（p < 0.002）。球囊扩张使肺动脉瓣口大小从平均9 + 5毫米增加到11.5 + 2毫米（p < 0.005）。肺动脉瓣的平均Z值在扩张前为 -3 + 1.3，手术后立即升至 -1.1 + 1.1（p < 0.05）。扩张后左右肺动脉大小分别从9毫米增加到10毫米，从8.7 + 2.4毫米增加到9.8 + 2.3毫米（p < 0.05）。左右分支的可比平均Z值分别从 -2.8 + 1.9标准差升至 -1.8 + 1.4标准差，从 -2.4 + 1.9标准差升至 -1.5 + 1.6标准差（p < 0.05）。在肺动脉干分叉处狭窄且左动脉发育不全的患者中，肺动脉瓣的成功扩张导致血流增加和发育不全节段大小改善。总之，法洛四联症患者初次肺动脉瓣球囊扩张导致肺动脉瓣Z值增加，改善了肺动脉前向血流，促使肺动脉生长，改善了术前的解剖和生理状况。
