O'Connor B K, Beekman R H, Lindauer A, Rocchini A
Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor 48109-0204.
J Am Coll Cardiol. 1992 Jul;20(1):169-73. doi: 10.1016/0735-1097(92)90154-f.
To assess late (4 to 5 years) gradient reduction after pulmonary balloon valvuloplasty in childhood, and to compare the effectiveness of valvuloplasty with that of surgical valvotomy, 20 valvuloplasty-treated children and their age- and gradient-matched surgical control patients underwent prospective, noninvasive evaluation. The average age at intervention was 4.3 +/- 1 years for the valvuloplasty group versus 4.7 +/- 0.8 years for the surgical control group (p = NS). Before intervention the peak systolic pulmonary stenosis gradient was 76 +/- 5 and 74 +/- 4.4 mm Hg for the valvuloplasty and surgery groups, respectively (p = NS). Late evaluation consisted of clinical examination, two-dimensional echocardiogram and Doppler study, 24-hour Holter monitoring, 12-lead electrocardiogram, exercise treadmill study and chest radiograph performed an average of 5.3 +/- 0.3 years after valvuloplasty and 11.7 +/- 0.5 years after surgery (p less than 0.01). The patients treated with balloon valvuloplasty had no evidence of restenosis; the residual pulmonary stenosis gradient at follow-up was 24 +/- 2.7 mm Hg (range 8 to 48) versus 35 +/- 3.6 mm Hg (range 19 to 70) immediately after valvuloplasty (p = NS). Comparison of the late residual gradients between treatment groups showed no hemodynamically significant difference (24 +/- 2.7 versus 16 +/- 1.5 mm Hg, balloon versus surgery; p less than 0.01). However, there was, a significant difference in the degree and severity of pulmonary valve insufficiency and ventricular ectopic activity between groups. In the balloon valvuloplasty group 11 patients had no pulmonary insufficiency, and the remaining 9 had mild insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)
为评估儿童期肺动脉球囊瓣膜成形术后晚期（4至5年）压力阶差降低情况，并比较瓣膜成形术与外科瓣膜切开术的疗效，对20例接受瓣膜成形术治疗的儿童及其年龄和压力阶差匹配的外科对照患者进行了前瞻性无创评估。瓣膜成形术组干预时的平均年龄为4.3±1岁，而外科对照组为4.7±0.8岁（p=无显著性差异）。干预前，瓣膜成形术组和手术组的收缩期肺动脉狭窄峰值压力阶差分别为76±5和74±4.4 mmHg（p=无显著性差异）。晚期评估包括临床检查、二维超声心动图和多普勒研究、24小时动态心电图监测、12导联心电图、运动平板试验和胸部X线检查，分别在瓣膜成形术后平均5.3±0.3年和手术后11.7±0.5年进行（p<0.01）。接受球囊瓣膜成形术治疗的患者无再狭窄证据；随访时残余肺动脉狭窄压力阶差为24±2.7 mmHg（范围8至48），而瓣膜成形术后即刻为35±3.6 mmHg（范围19至70）（p=无显著性差异）。治疗组间晚期残余压力阶差比较显示无血流动力学显著差异（球囊瓣膜成形术组与手术组分别为24±2.7与16±1.5 mmHg；p<0.01）。然而，两组间肺动脉瓣关闭不全程度和严重程度以及室性异位活动存在显著差异。在球囊瓣膜成形术组中，11例患者无肺动脉瓣关闭不全，其余9例有轻度关闭不全。（摘要截断于250字）
