Ino T, Okubo M, Akimoto K, Shimazaki S, Nishimoto K, Iwahara M, Yabuta K, Watanabe M, Hosoda Y
Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan.
Jpn Circ J. 1992 Jun;56(6):535-43. doi: 10.1253/jcj.56.535.
The purpose of this study is to report our experience regarding the acute and intermediate-term results of balloon pulmonary valvuloplasty (BPV) in various types of congenital pulmonary valve stenosis.
Twenty-four consecutive patients with a median age of 6.6 years (ranging from 1 month to 24 years old) underwent BPV between January 1988 and September 1991. These patients were divided into 2 groups; Group 1 consisting of 13 patients with isolated pulmonary valve stenosis, and Group 2 consisting of 11 patients with complicated pulmonary valve stenosis (supravalvular, subvalvular, valved conduit and post-right ventricular outflow reconstruction). Mean peak systolic pressure gradients from the right ventricle to the pulmonary artery were as follows: In group 1, 48 +/- 21 (mean +/- SD) mmHg before BPV, 18 +/- 8 mmHg immediately after BPV and 13 +/- 5 mmHg at the longest follow-up based on catheterization or Doppler echocardiographic studies. The gradients in group 2 were 65 +/- 28 mmHg before BPV, 46 +/- 25 mmHg immediately after BPV and 47 +/- 21 mmHg at the longest follow-up.
BPV provides both acute and intermediate-term gradient relief in patients with isolated pulmonary valve stenosis. In complicated pulmonary valve stenosis, on the other hand, the effect of BPV was unsatisfactory and appears to depend on the mechanism of associated obstruction. Therefore accurate evaluation of the anatomy of associated obstruction in the pulmonary valve region is needed to determine that BPV is indicated.
本研究的目的是报告我们在各类先天性肺动脉瓣狭窄中进行球囊肺动脉瓣成形术（BPV）的急性和中期结果方面的经验。
1988年1月至1991年9月期间，连续24例患者接受了BPV，中位年龄为6.6岁（范围从1个月至24岁）。这些患者被分为两组；第1组由13例孤立性肺动脉瓣狭窄患者组成，第2组由11例复杂性肺动脉瓣狭窄患者组成（瓣上、瓣下、带瓣管道及右心室流出道重建术后）。右心室至肺动脉的平均收缩期峰值压力阶差如下：在第1组中，BPV术前为48±21（均值±标准差）mmHg，BPV术后即刻为18±8 mmHg，基于心导管检查或多普勒超声心动图研究的最长随访时为13±5 mmHg。第2组的压力阶差在BPV术前为65±28 mmHg，BPV术后即刻为46±25 mmHg，最长随访时为47±21 mmHg。
BPV可使孤立性肺动脉瓣狭窄患者的急性和中期压力阶差降低。另一方面，在复杂性肺动脉瓣狭窄中，BPV的效果并不理想，且似乎取决于相关梗阻的机制。因此，需要准确评估肺动脉瓣区域相关梗阻的解剖结构，以确定是否适合进行BPV。
