Fawzy M E, Awad M, Galal O, Shoukri M, Hegazy H, Dunn B, Mimish L, Al Halees Z
Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
J Heart Valve Dis. 2001 Nov;10(6):812-8.
The study aim was to define the long-term outcome of pulmonary balloon valvulotomy (PBV) in adult patients.
PBV was performed in 87 patients (46 females, 41 males; mean age 23+/-9 years; range: 15-54 years) with congenital pulmonary valve stenosis (PS). Intermediate follow up catheterization (mean 14.6+/-5.0; range: 6-24 months) was performed after PBV in 53 patients. Clinical and Doppler echocardiography examinations were carried out annually in 82 patients (mean 8.0+/-3.9; range: 2-15 years).
There were no immediate or late deaths. The mean catheter peak pulmonary gradient (PG) before and immediately after PBV, and at intermediate follow up was 105+/-39, 34+/-26 (p <0.0001) and 17+/-14 (p <0.0001) mmHg, respectively. The corresponding values for right ventricular (RV) pressure were 125+/-38, 59+/-21 (p <0.0001) and 42+/-12 (p <0.0001) mmHg, respectively. The infundibular gradients immediately after PBV and at intermediate follow up were 31+/-23 and 14+/-9 mmHg (p <0.0001), whilst cardiac index improved from 2.68+/-0.73 to 3.1+/-0.4 l/min/m2 (p <0.05) at intermediate follow up. Doppler PG before PBV and at intermediate and long-term follow up were 91+/-33 (range 36-200) mmHg, 28+/-12 (range 10-60) mmHg (p <0.0001) and 26+/-11 mmHg (p = 0.2), respectively. New pulmonary regurgitation (PR) was noted in 21 patients (25%) after PBV. Five patients (6%) with a suboptimal result (immediate valve gradient > or =30 mmHg) developed restenosis and underwent repeat valvulotomy 6-12 months later using a larger balloon, and with satisfactory outcome. Moderate to severe tricuspid regurgitation (TR) in seven patients regressed after PBV.
The long-term results of PBV in adults are excellent, with regression of concomitant, severe infundibular stenosis and/or severe TR. Hence, PBV should be considered as the treatment of choice for adult patients with PS.
本研究旨在明确成年患者肺动脉球囊瓣膜成形术（PBV）的长期疗效。
对87例先天性肺动脉瓣狭窄（PS）患者（46例女性，41例男性；平均年龄23±9岁；范围：15 - 54岁）实施PBV。53例患者在PBV术后进行了中期随访心导管检查（平均14.6±5.0；范围：6 - 24个月）。82例患者（平均8.0±3.9；范围：2 - 15年）每年进行临床及多普勒超声心动图检查。
无即刻或晚期死亡病例。PBV术前、术后即刻及中期随访时的平均心导管肺动脉峰值压差（PG）分别为105±39、34±26（p<0.0001）和17±14（p<0.0001）mmHg。右心室（RV）压力的相应值分别为125±38、59±21（p<0.0001）和42±12（p<0.0001）mmHg。PBV术后即刻及中期随访时漏斗部压差分别为31±23和14±9 mmHg（p<0.0001），而中期随访时心脏指数从2.68±0.73改善至3.1±0.4 l/min/m2（p<0.05）。PBV术前、中期及长期随访时的多普勒PG分别为91±33（范围36 - 200）mmHg、28±12（范围10 - 60）mmHg（p<0.0001）和26±11 mmHg（p = 0.2）。PBV术后21例患者（25%）出现新的肺动脉反流（PR）。5例（6%）效果欠佳（即刻瓣膜压差≥30 mmHg）的患者发生再狭窄，并在6 - 12个月后使用更大的球囊进行了再次瓣膜成形术，结果满意。7例患者的中重度三尖瓣反流（TR）在PBV术后减轻。
成年患者PBV的长期效果良好，同时存在的严重漏斗部狭窄和/或严重TR减轻。因此，PBV应被视为成年PS患者治疗的首选方法。
