Zain Zarin, Zadinello Mariutzka, Menahem Samuel, Brizard Christian
Department of Cardiology, Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Flemington Road, Parkville, Vic. 3052, Melbourne, Australia.
Heart Lung Circ. 2006 Feb;15(1):18-23. doi: 10.1016/j.hlc.2005.02.003. Epub 2005 Jul 25.
Open surgical valvotomy and transcatheter balloon valvuloplasty are recognised treatments for neonatal critical aortic stenosis.
A retrospective analysis was undertaken of all newborns with critical aortic valve stenosis between 1990 and 2000 presenting to a tertiary centre and who required intervention. The initial catheter and surgical intervention was generally based on the preference of the attending cardiologist and the anatomy of the aortic valve and in consultation with the cardiothoracic surgeon. The two groups were therefore not strictly comparable. Twelve were subjected to balloon valvuloplasty and thirteen to surgical valvotomy at a median age of 11 days (2-42 days) and 3.5 days (1-19 days) respectively. There was no significant difference in the timing of the procedure, weight of the infant, aortic annulus or left ventricular dimensions in either group.
There was one unrelated hospital death in the balloon group compared to two in the surgical group both of whom had endocardial fibroelastosis. Mild to moderate aortic regurgitation was seen after both procedures. Four patients in the balloon valvuloplasty group, developed femoral artery thrombosis and two had cardiac perforation that resolved with non operative management. The mean Doppler gradient was reduced from 44+/-14 mmHg to 13.4+/-5 mmHg (p<0.01) in the valvuloplasty group compared to a reduction from 42+/-15 mmHg to 27+/-8 mmHg (p<0.05) in the surgical group. Five patients in the balloon group required re-intervention within 3 weeks to 21 months after the initial procedure. Two patients in the surgical group required a pulmonary autograft and Konno Procedure 3 and 5 years following surgical valvotomy.
Both aortic valvuloplasty and valvotomy offered effective short and medium term palliation. Balloon valvuloplasty patients had a higher re-intervention rate but shorter hospital and intensive care stay, reduced immediate morbidity and were associated with less severe aortic regurgitation.
开放性外科瓣膜切开术和经导管球囊瓣膜成形术是公认的治疗新生儿重症主动脉瓣狭窄的方法。
对1990年至2000年间在一家三级中心就诊且需要干预的所有重症主动脉瓣狭窄新生儿进行回顾性分析。最初的导管和外科干预通常基于主治心脏病专家的偏好、主动脉瓣的解剖结构，并与心胸外科医生协商。因此，两组并非严格可比。12例接受球囊瓣膜成形术，13例接受外科瓣膜切开术，中位年龄分别为11天（2 - 42天）和3.5天（1 - 19天）。两组在手术时机、婴儿体重、主动脉瓣环或左心室尺寸方面均无显著差异。
球囊组有1例与手术无关的医院死亡，而手术组有2例，均患有心内膜弹力纤维增生症。两种手术后均可见轻至中度主动脉瓣反流。球囊瓣膜成形术组有4例患者发生股动脉血栓形成，2例发生心脏穿孔，经非手术治疗后好转。瓣膜成形术组平均多普勒压差从44±14 mmHg降至13.4±5 mmHg（p<0.01），而手术组从42±15 mmHg降至27±8 mmHg（p<0.05）。球囊组有5例患者在初次手术后3周内至21个月需要再次干预。手术组有2例患者在外科瓣膜切开术后3年和5年需要进行肺动脉自体移植和Konno手术。
主动脉瓣成形术和瓣膜切开术均提供了有效的短期和中期缓解。球囊瓣膜成形术患者的再次干预率较高，但住院和重症监护时间较短，即时发病率降低，且主动脉瓣反流较轻。
