Peterson Claire, Schilthuis Johanneke J, Dodge-Khatami Ali, Hitchcock J Francois, Meijboom Erik J, Bennink Ger B W E
Division of Cardiology, Wilhelmina Children's Hospital, University of Utrecht, The Netherlands.
Ann Thorac Surg. 2003 Oct;76(4):1078-82; discussion 1082-3. doi: 10.1016/s0003-4975(03)00678-7.
We compared the long-term results of surgical valvotomy (S) versus balloon valvuloplasty (BV) for pulmonary valve stenosis in infants and children.
Results after surgical pulmonary valvotomy (with concomitant ASD/VSD closure) (n = 62, age 2.9 +/- 3.5 years) and balloon valvuloplasty (n = 108, age 3.6 +/- 3.9 years) were analyzed. Transvalvular mean pressure gradient decrease, freedom from reintervention for restenosis, pulmonary valve insufficiency, and tricuspid valve insufficiency were considered.
Mean pressure gradient decreased significantly more in the surgical group (from 64.8 +/- 30.8 mm Hg to 12.8 +/- 9.8 mm Hg at a mean follow-up of 9.8 years) than after BV (decreasing from 66.2 +/- 21.4 mm Hg to 21.5 +/- 15.9 mm Hg after a mean of 5.4 years; p < 0.001). Moderate pulmonary valve insufficiency occurred in 44% after surgery, and in 11% after BV (p < 0.001). Tricuspid valve insufficiency occurred in 2% after surgery, and in 5% after BV. Restenosis occurred in 3 surgical patients (5.6%), 2 patients required reoperation, and 1 patient required a balloon valvotomy. Restenosis developed in 13 BV patients (14.1%): 6 patients were redilated and 7 patients required surgery. Surgical valvotomy led to significantly less reinterventions than balloon valvuloplasty (p < 0.04).
Surgical relief of pulmonary valve stenosis produces lower long-term gradients and results in longer freedom from reintervention. Balloon valvuloplasty may remain, despite these results, the preferred therapy for isolated pulmonary valve stenosis, because it is less invasive, less expensive, and requires a shorter hospital stay. Surgery should remain the exclusive form of therapy in the presence of concomitant intracardiac defects, which need to be addressed.
我们比较了婴儿和儿童肺动脉瓣狭窄的外科瓣膜切开术（S）与球囊瓣膜成形术（BV）的长期结果。
分析了外科肺动脉瓣切开术（同时闭合房间隔缺损/室间隔缺损）（n = 62，年龄2.9±3.5岁）和球囊瓣膜成形术（n = 108，年龄3.6±3.9岁）后的结果。考虑跨瓣膜平均压力阶差降低、免于因再狭窄进行再次干预、肺动脉瓣关闭不全和三尖瓣关闭不全情况。
外科手术组平均压力阶差降低幅度显著大于球囊瓣膜成形术后（平均随访9.8年时，从64.8±30.8 mmHg降至12.8±9.8 mmHg），球囊瓣膜成形术后平均压力阶差从66.2±21.4 mmHg降至21.5±15.9 mmHg（平均5.4年；p < 0.001）。外科手术后44%出现中度肺动脉瓣关闭不全，球囊瓣膜成形术后为11%（p < 0.001）。外科手术后2%出现三尖瓣关闭不全，球囊瓣膜成形术后为5%。3例外科手术患者（5.6%）出现再狭窄，2例患者需要再次手术，1例患者需要球囊瓣膜切开术。13例球囊瓣膜成形术患者（14.1%）出现再狭窄：6例患者再次扩张，7例患者需要手术。外科瓣膜切开术导致的再次干预明显少于球囊瓣膜成形术（p < 0.04）。
外科手术缓解肺动脉瓣狭窄产生的长期压力阶差更低，且免于再次干预的时间更长。尽管有这些结果，但球囊瓣膜成形术可能仍是孤立性肺动脉瓣狭窄的首选治疗方法，因为它侵入性较小、费用较低且住院时间较短。对于存在需要处理的合并心内缺损的情况，手术仍应是唯一的治疗方式。
