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[经皮球囊肺动脉瓣成形术的短期和长期结果]

[Short- and long- term results of percutaneous balloon valvuloplasty in pulmonary valve stenosis].

作者信息

Hatem Domingos M, Castro Iran, Haertel José Carlos, Rossi Raul I, Zielinsky Paulo, Leboute Flávio C, Pomar Nara, Winckler Maristela, Kersten Rogério N, Cardoso Carlos Roberto, Gottschall Carlos A M

机构信息

Instituto de Cardiologia, RS/Fundação Universitária de Cardiologia.

出版信息

Arq Bras Cardiol. 2004 Mar;82(3):221-7. doi: 10.1590/s0066-782x2004000300003. Epub 2004 Apr 5.

Abstract

OBJECTIVE

To assess the long-term results of percutaneous balloon valvuloplasty at a single institution.

METHODS

This study comprised 189 patients with pulmonary valve stenosis undergoing percutaneous balloon valvuloplasty from 1984 to 1996, whose mean age was 7.97+/-9.25 years. The procedure was classified as successful when the RV-PA gradient was reduced to levels < 36 mmHg; restenosis was indicated by RV-PA gradients > 36 mmHg after an effective procedure.

RESULTS

After the procedure, the peak-to-peak transvalvular gradient decreased from 70.12+/-30.06 to 25.11 +/-20.23 mmHg (P<0.001). Immediate success was obtained in 148 (78.72%) patients. A later reduction in the gradient to values < 36 mmHg was obtained in 24 other patients previously categorized as unsuccessful. Therefore, percutaneous balloon valvuloplasty was considered effective in 172 (91.01%) patients. Effectiveness increased to 93.53% (159/170) in the cases of typical morphology. Follow-up ranged from 4.39+/-3 years to 13.01 years. Restenosis was observed in 24 (13.95%) patients. Pulmonary regurgitation was detected in 95.1% of the patients, being more intense than mild in 29.5% of the patients. The probability of maintaining an appropriate result, at any time point, with no restenosis was 92.29% in 2 years, 87.38% in 5 years, 82.46% in 8 years, and 64.48% in 10 years.

CONCLUSION

Percutaneous balloon valvuloplasty was effective and safe for the treatment of pulmonary valve stenosis with excellent short- and long-term results.

摘要

目的

评估在单一机构进行经皮球囊瓣膜成形术的长期效果。

方法

本研究纳入了1984年至1996年间接受经皮球囊瓣膜成形术的189例肺动脉瓣狭窄患者,其平均年龄为7.97±9.25岁。当右心室-肺动脉压差降至<36 mmHg时,该手术被判定为成功;有效手术后右心室-肺动脉压差>36 mmHg则提示再狭窄。

结果

术后,跨瓣膜压差峰值从70.12±30.06 mmHg降至25.11±20.23 mmHg(P<0.001)。148例(78.72%)患者即刻获得成功。另外24例先前被判定为手术失败的患者,其压差后来也降至<36 mmHg。因此,172例(91.01%)患者的经皮球囊瓣膜成形术被认为是有效的。典型形态病例的有效率增至93.53%(159/170)。随访时间为4.39±3年至13.01年。24例(13.95%)患者出现再狭窄。95.1%的患者检测到肺动脉反流,其中29.5%的患者反流程度超过轻度。在任何时间点,无再狭窄且维持适当效果的概率在2年时为92.29%,5年时为87.38%,8年时为82.46%,10年时为64.48%。

结论

经皮球囊瓣膜成形术治疗肺动脉瓣狭窄有效且安全,短期和长期效果均良好。

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