Rhodes J, O'Brien S, Patel H, Cao Q L, Banerjee A, Hijazi Z M
Division of Pediatric Cardiology, Floating Hospital for Children, 750 Washington Street, Box 313, Boston, MA 02111, USA.
J Invasive Cardiol. 2000 Sep;12(9):448-51.
Although balloon pulmonary valvuloplasty (BPV) has been advocated as a means of palliating patients with tetralogy of Fallot (TOF), the results of this procedure were not uniformly good in this patient population. The purpose of this study was to review our institutionOs experience with BPV in patients with TOF, and to determine whether echocardiographic criteria exist that may be used to identify patients likely to derive prolonged benefit from this procedure. Between 1991 and 1999, nine patients with TOF, ages 0. 4Eth 26.1 weeks (mean, 7.4 +/- 7.6 weeks) underwent BPV due to cyanosis and other associated medical conditions (e.g., coronary artery anomalies, small size) that rendered immediate surgical intervention undesirable. Data from the catheterization and pre-BPV echocardiograms were analyzed. All patients had at least transient improvement in oxygen saturation. However, 4 patients (Group 1) required intervention (1 open-heart repair, 3 palliative shunts) within 5 weeks of BPV due to recurrent desaturation. In the remaining 5 patients (Group 2), open-heart repair was delayed 8Eth 36 weeks (mean, 23 +/- 13 weeks). Groups 1 and 2 did not differ regarding pulmonary valve annulus, main pulmonary artery or branch pulmonary artery diameter. However, the diastolic diameter of the right ventricular outflow tract (RVOT) was significantly smaller in Group 1 (18.3 +/- 3.5 mm/m2 versus 24.4 +/- 4.1 mm/m2 in Group 2; p < 0.05). Four out of five patients with a RVOT diameter < 23 mm/m2 were in Group 1, and all patients with RVOT diameter greater than 25 mm/m2 were in Group 2. We conclude that BPV can effectively palliate patients with TOF whose RVOT diastolic diameter is > 25 mm/m2. However, patients with a diastolic RVOT diameter < 23 mm/m2 are unlikely to have sustained improvement following BPV.
尽管球囊肺动脉瓣成形术（BPV）已被提倡作为一种缓解法洛四联症（TOF）患者症状的方法，但该手术在这一患者群体中的效果并不一致良好。本研究的目的是回顾我们机构对TOF患者进行BPV的经验，并确定是否存在超声心动图标准，可用于识别可能从该手术中获得长期益处的患者。1991年至1999年间，9例TOF患者，年龄0.4至26.1周（平均7.4±7.6周），因发绀和其他相关内科疾病（如冠状动脉异常、体型小）而接受BPV，这些情况使得立即进行手术干预不可取。对心导管检查和BPV术前超声心动图的数据进行了分析。所有患者的血氧饱和度至少有短暂改善。然而，4例患者（第1组）在BPV后5周内由于反复出现血氧饱和度下降而需要干预（1例进行心脏直视修复，3例进行姑息性分流术）。其余5例患者（第2组），心脏直视修复术延迟了8至36周（平均23±13周）。第1组和第2组在肺动脉瓣环、主肺动脉或分支肺动脉直径方面没有差异。然而，第1组右心室流出道（RVOT）的舒张期直径明显较小（分别为18.3±3.5mm/m²和第2组的24.4±4.1mm/m²；p<0.05）。RVOT直径<23mm/m²的5例患者中有4例在第1组，而RVOT直径大于25mm/m²的所有患者均在第2组。我们得出结论，BPV可以有效缓解RVOT舒张期直径>25mm/m²的TOF患者的症状。然而，RVOT舒张期直径<23mm/m²的患者在BPV后不太可能有持续改善。
