类癌性肺动脉瓣狭窄球囊扩张术失败
Failure of balloon dilatation of the pulmonary valve in carcinoid pulmonary stenosis.
作者信息
Grant S C, Scarffe J H, Levy R D, Brooks N H
机构信息
Wythenshawe Hospital, Manchester.
出版信息
Br Heart J. 1992 Jun;67(6):450-3. doi: 10.1136/hrt.67.6.450.
BACKGROUND
Carcinoid heart disease typically results in pulmonary stenosis and tricuspid incompetence. Percutaneous balloon dilatation is an effective treatment for congenital pulmonary stenosis and has been applied successfully to tricuspid stenosis caused by carcinoid heart disease. The value of balloon dilatation of the pulmonary valve in carcinoid pulmonary stenosis was assessed.
METHODS
Two patients with severe congestive heart failure secondary to carcinoid heart disease and with documented pulmonary stenosis had balloon dilatation of the pulmonary valve. In both cases tricuspid regurgitation was also present together with reduced cardiac output.
RESULTS
The procedure was technically successful in both patients. One patient experienced symptomatic benefit for two months and the other experienced no improvement. Both patients subsequently required combined tricuspid and pulmonary valve replacement from which good results and symptomatic improvement were obtained.
CONCLUSION
Though balloon dilatation of the pulmonary valve is technically feasible it is unlikely to provide useful palliation in carcinoid heart disease. Valve surgery should be considered in patients in whom the malignancy is controlled but carcinoid heart disease is producing drug resistant congestive heart failure.
背景
类癌性心脏病通常导致肺动脉狭窄和三尖瓣关闭不全。经皮球囊扩张术是治疗先天性肺动脉狭窄的有效方法，并已成功应用于类癌性心脏病所致的三尖瓣狭窄。评估了球囊扩张术在类癌性肺动脉狭窄中对肺动脉瓣的治疗价值。
方法
两名因类癌性心脏病继发严重充血性心力衰竭且有肺动脉狭窄记录的患者接受了肺动脉瓣球囊扩张术。两例患者均合并三尖瓣反流且心输出量降低。
结果
该操作在两名患者中技术上均获成功。一名患者在两个月内症状得到改善，另一名患者则无改善。两名患者随后均需要进行三尖瓣和肺动脉瓣联合置换，术后取得了良好效果且症状得到改善。
结论
尽管肺动脉瓣球囊扩张术在技术上可行，但不太可能为类癌性心脏病提供有效的姑息治疗。对于恶性肿瘤得到控制但类癌性心脏病导致耐药性充血性心力衰竭的患者，应考虑进行瓣膜手术。
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