Satou G M, Perry S B, Lock J E, Piercey G E, Keane J F
Department of Cardiology, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Catheter Cardiovasc Interv. 1999 May;47(1):47-51. doi: 10.1002/(SICI)1522-726X(199905)47:1<47::AID-CCD10>3.0.CO;2-O.
While balloon dilation (BD) has become the initial treatment for congenital valvar aortic stenosis (CVAS) at many institutions, repeat BD for recurrent obstruction has been reported only in a few. Between January 1985 and December 1996, 298 patients (70 neonates) underwent BD, 34 of whom underwent a repeat BD without mortality. A greater proportion of neonates had a repeat BD (26% vs. 8%, P < 0.001). At repeat BD (1 day-7.5 years post initial BD), the mean peak-to-peak gradient was reduced from 67+/-24 to 36+/-16 mm Hg (P < 0.0001). Aortic regurgitation (AR) increased immediately in 26%, being moderate or more in 24%. During a mean follow-up of 5.2 years, there was one surgically related death. Of the 33 survivors, 6 had surgery for residual stenosis and/or AR. Among the remaining 27 patients, 96% were asymptomatic, the peak instantaneous aortic valve Doppler gradient was 50+/-15 mm Hg with AR absent in 8%, mild in 62%, and moderate or more in 31%. In conclusion, repeat BD is effective and without mortality. AR was at least moderate in 24% of patients immediately after a second BD. Repeat BD was more common in patients who underwent the initial BD as neonates.
虽然球囊扩张术（BD）已成为许多机构先天性瓣膜主动脉狭窄（CVAS）的初始治疗方法，但仅有少数关于复发性梗阻的重复球囊扩张术的报道。1985年1月至1996年12月期间，298例患者（70例新生儿）接受了球囊扩张术，其中34例接受了重复球囊扩张术，无一例死亡。新生儿接受重复球囊扩张术的比例更高（26%对8%，P<0.001）。在重复球囊扩张术时（初次球囊扩张术后1天至7.5年），平均峰-峰压差从67±24降至36±16 mmHg（P<0.0001）。26%的患者主动脉反流（AR）立即增加，其中24%为中度或更严重。在平均5.2年的随访中，有1例手术相关死亡。在33名幸存者中，6例因残余狭窄和/或主动脉反流接受了手术。在其余27例患者中，96%无症状，主动脉瓣瞬时峰值多普勒压差为50±15 mmHg，8%无主动脉反流，62%为轻度，31%为中度或更严重。总之，重复球囊扩张术有效且无死亡病例。第二次球囊扩张术后立即有24%的患者主动脉反流至少为中度。重复球囊扩张术在新生儿期接受初次球囊扩张术的患者中更为常见。
