Robinson B V, Brzezinska-Rajszys G, Weber H S, Ksiazyk J, Fricker F J, Fischer D R, Ettedgui J A
University of North Carolina, Chapel Hill, USA.
Cardiol Young. 2000 May;10(3):225-32. doi: 10.1017/s104795110000915x.
The purpose of this study was to evaluate the short and intermediate term results of infants who have undergone balloon aortic valvotomy from the carotid arterial approach, and to identify risk factors in those infants who had a poor outcome.
Between 1988 and 1999, balloon aortic valvotomy was attempted at four centres in 95 infants with severe aortic stenosis. Echocardiographic and hemodynamic data, and outcome, were analysed retrospectively.
Valvotomy was accomplished in 92 of the 95 infants, with a median age of 5 days, a range from 0 to 191 days, and weighing 3.4 kg, with a range from 1.0 to 6.5 kg. Major procedural complications occurred in 10 infants. Post-procedural aortic regurgitation was severe in 5 patients. There were 13 early deaths, and 4 late deaths. The period of mean follow-up has been 2.1 years, with a range from 0 to 9.3 years. The actuarial survival at 3 years was 76 +/- 6%. Further interventions were needed in 19 patients, giving a 3-year freedom from reintervention of 67 +/- 6%. The 51 infants who were duct-dependent were further analyzed, and found to have a higher mortality (38%) compared to those infants not dependent on the arterial duct (5%). Risk factors for a poor outcome in the duct-dependent infants were mitral stenosis (p<0.005), a left ventricle which did not form the cardiac apex (p<0.005), and an aortic valve with a diameter of less than 6 mm (p<0.05).
This multi-centric registry shows good results in the intermediate term for treating infants with severe aortic valvar stenosis with balloon valvotomy through a carotid arterial cutdown. Infants dependent on prostaglandin had a worse outcome, especially if they had any of the identified risk factors.
本研究旨在评估经颈动脉途径行球囊主动脉瓣切开术的婴儿的短期和中期结果，并确定预后不良的婴儿的危险因素。
1988年至1999年间，四个中心对95例重度主动脉狭窄婴儿尝试进行球囊主动脉瓣切开术。对超声心动图、血流动力学数据及结果进行回顾性分析。
95例婴儿中有92例完成了瓣膜切开术，中位年龄5天，范围0至191天，体重3.4kg，范围1.0至6.5kg。10例婴儿出现主要手术并发症。5例患者术后主动脉瓣反流严重。有13例早期死亡和4例晚期死亡。平均随访期为2.1年，范围0至9.3年。3年时的精算生存率为76±6%。19例患者需要进一步干预，3年无再次干预率为67±6%。对51例依赖动脉导管的婴儿进行进一步分析，发现其死亡率（38%）高于不依赖动脉导管的婴儿（5%）。依赖动脉导管的婴儿预后不良的危险因素为二尖瓣狭窄（p<0.005）、左心室未形成心尖（p<0.005）和主动脉瓣直径小于6mm（p<0.05）。
这个多中心注册研究表明，经颈动脉切开行球囊瓣膜切开术治疗重度主动脉瓣狭窄婴儿的中期效果良好。依赖前列腺素的婴儿预后较差，尤其是如果他们有任何已确定的危险因素。
