Moura Cláudia, Carriço Ana, Baptista M João, Vieira António, Silva João Carlos, Moreira Jorge, Areias José Carlos
Serviço de Cardiologia Pediátrica e Laboratório de Hemodinâmica, Hospital de São João, Porto, Portugal.
Rev Port Cardiol. 2004 Jan;23(1):55-63.
Evaluation of the global results after percutaneous pulmonary valvotomy with a balloon catheter performed in the first year of life.
We assessed retrospectively the data of 27 patients with pulmonary stenosis who underwent balloon valvotomy in the first 12 months of life, from January 1994 to July 2002. The following data were evaluated: gender, age at diagnosis, clinical presentation, echocardiographic features, other cardiac anomalies, age at balloon valvotomy, diameter of pulmonary annulus, initial and final pressure gradient across the valve, complications and follow-up. We used the median and the Wilcoxon test. For other variables we present the mean and standard deviation.
Fourteen patients (52%) were female. We had two prenatal diagnoses. Age at diagnosis ranged between one and 60 days (median: 28.0). With regard to clinical presentation, one (4%) had isolated cyanosis, seven (28%) a systolic murmur and 17 (68%) both cyanosis and a systolic murmur. Associated malformations included: ventricular septal defect--two, dilatation of left pulmonary artery--one, supravalvar stenosis--one, and subvalvular membrane--one. The pulmonary annulus ranged between 4.5 and 11 mm (mean: 8.3 +/- 1.8). The procedure was performed in 23 patients aged 2 to 357 days (median: 60), 43.5% of cases in the first 28 days of life. Balloon diameter ranged from six to 14 mm (mean: 10.7 +/- 2.3). The median value of right ventricular peak systolic pressure before dilatation was 115 mmHg (variation: 60-212) and decreased to 48 mmHg (variation: 20-120) (p < 0.001). Significant infundibular stenosis was documented in five cases and propranolol was initiated after the procedure. In four cases the procedure was abandoned before dilatation. The follow-up period ranged from 0 to 101 months (mean: 40.1 +/- 32.1). The maximum instantaneous gradient between the right ventricle and the pulmonary artery ranged between 0 and 95 mmHg (mean: 23.7 +/- 19.5), and was more than 40 mmHg in 13% of the cases.
Percutaneous pulmonary valvotomy with a balloon catheter performed in the first year of life is effective in relieving obstruction of the right ventricular outflow tract. The success rate was 78% (21 of 27 patients).
评估在出生后第一年采用球囊导管进行经皮肺动脉瓣切开术的整体效果。
我们回顾性评估了1994年1月至2002年7月间27例在出生后12个月内接受球囊瓣膜切开术的肺动脉狭窄患者的数据。评估了以下数据：性别、诊断时年龄、临床表现、超声心动图特征、其他心脏异常、球囊瓣膜切开术时的年龄、肺动脉瓣环直径、瓣膜两端的初始和最终压力阶差、并发症及随访情况。我们使用了中位数和威尔科克森检验。对于其他变量，我们给出了均值和标准差。
14例（52%）为女性。有2例产前诊断。诊断时年龄在1至60天之间（中位数：28.0天）。关于临床表现，1例（4%）仅有发绀，7例（28%）有收缩期杂音，17例（68%）既有发绀又有收缩期杂音。相关畸形包括：室间隔缺损2例、左肺动脉扩张1例、瓣上狭窄1例、瓣下隔膜1例。肺动脉瓣环直径在4.5至11毫米之间（均值：8.3±1.8毫米）。该手术在23例年龄为2至357天（中位数：60天）的患者中进行，43.5%的病例在出生后28天内进行。球囊直径范围为6至14毫米（均值：10.7±2.3毫米）。扩张前右心室收缩压峰值中位数为115毫米汞柱（范围：60 - 212毫米汞柱），术后降至48毫米汞柱（范围：20 - 120毫米汞柱）（p < 0.001）。5例记录有明显的漏斗部狭窄，术后开始使用普萘洛尔。4例在扩张前放弃手术。随访期为0至101个月（均值：40.1±32.1个月）。右心室与肺动脉之间的最大瞬间压力阶差在0至95毫米汞柱之间（均值：23.7±19.5毫米汞柱），13%的病例超过40毫米汞柱。
在出生后第一年采用球囊导管进行经皮肺动脉瓣切开术可有效缓解右心室流出道梗阻。成功率为78%（27例患者中的21例）。
