Worms A M, Marçon F, Chehab G, Michalski H
Service de cardiologie infantile, CHU Nancy-Brabois, Vandoeuvre.
Arch Mal Coeur Vaiss. 1992 May;85(5):527-31.
Fifty balloon angioplasties of branch pulmonary artery stenosis in 34 patients aged 4 months to 20 years, performed in 7 French Centres, were included in this study: they were performed from 1984 to 1991 and concerned severe stenoses which were congenital in 36 cases and secondary to surgery in 14 cases. The criteria of inclusion were: diameter of stenosis less than or equal to 8 mm, right ventricular systolic pressure (RVP) greater than or equal to 50 mmHg, RVP/aortic pressure ratio (RVP/AO) greater than or equal to 50%, and a significant perfusion defect on radionuclide angioscintigraphy. There were no operative complications. The diameter of the stenosis increased by greater than 40% in 23 cases (46%); in only 7 of these cases (14%) did the RVP and RVP/AO ratio decrease by more than 20%, the RVP being less than 50 mmHg, or did the perfusion scintigraphy improve. No cases of restenosis were observed. The reasons for failure are discussed together with the limitations of this study. The respective indications of surgery and angioplasty are not easy to determine for these complicated lesions. New techniques such as the use of stents should improve results.
本研究纳入了法国7个中心对34例年龄在4个月至20岁的患者进行的50次分支肺动脉狭窄球囊血管成形术：手术时间为1984年至1991年，涉及严重狭窄，其中36例为先天性，14例为手术后继发性。纳入标准为：狭窄直径小于或等于8 mm，右心室收缩压（RVP）大于或等于50 mmHg，RVP/主动脉压比值（RVP/AO）大于或等于50%，以及放射性核素血管闪烁造影显示明显灌注缺损。无手术并发症。23例（46%）狭窄直径增加超过40%；其中仅7例（14%）RVP和RVP/AO比值下降超过20%，RVP小于50 mmHg，或灌注闪烁造影有所改善。未观察到再狭窄病例。讨论了失败原因及本研究的局限性。对于这些复杂病变，手术和血管成形术各自的适应证不易确定。使用支架等新技术应能改善治疗效果。
