Sánchez Agustín, David Felipe, Velázquez Enrique, Yáñez Lucelly, Jiménez Santiago, Martínez Arturo, Ortegón José, López Diana, Lascano Sonia, Alva Carlos
Servicio de Cardiopatías Congénitas, Hospital de Cardiología del Centro Médico Nacional Siglo XXI, México, DF.
Arch Cardiol Mex. 2005 Oct-Dec;75(4):455-9.
To evaluate rapid ventricular pacing in balloon aortic valvuloplasty, an initial strategy to achieve balloon stability.
From September to December 2004, a prospective protocol was started: three male consecutive patients with aortic valve stenosis were treated by this strategy. Age of the patients were 13, 6 and 5 years old. All had a bipoplar pacing catheter placed in the right ventricle. Invasive systemic pressures were documented with a catheter in the descending aorta. Rapid ventricular pacing was initiated at the rate of 150 per minute and increased to a rate required to achieve a drop in systemic pressure by 50%. The balloon was inflated only after the pacing rate was reached and the blood pressure dropped. Pacing was continued until the balloon was completely deflated.
The systolic gradients across the aortic valve before balloon dilatation were 90, 110 and 55 mmHg. The systolic pressures in aorta were 90 and 110 mmHg. The pacing rate to drop the pressure by 50% were 170, 250 and 220 per minute. The pacing time was 15 seconds in all patients. Balloon stability at time of inflation was achieved in all cases with no balloon movement. The post-ballooning gradients were 23, 28 and 15 mmHg. Angiogram performed post balloon dilatation showed no change compared with the pre-balloning angiogram in aorta: trivial aortic incompetence in the first case and none in the second and third cases.
Rapid ventricular pacing to stabilise the balloon during balloon aortic valvuloplasty seems to be safe and effective and may decrease the incidence of aortic incompetence.
评估在球囊主动脉瓣成形术中进行快速心室起搏，这是实现球囊稳定的初始策略。
2004年9月至12月，启动了一项前瞻性方案：连续3例男性主动脉瓣狭窄患者接受了该策略治疗。患者年龄分别为13岁、6岁和5岁。所有患者均在右心室置入双极起搏导管。通过降主动脉内的导管记录有创体循环压力。以每分钟150次的频率开始快速心室起搏，并增加至使体循环压力下降50%所需的频率。仅在达到起搏频率且血压下降后才充盈球囊。起搏持续至球囊完全放气。
球囊扩张前主动脉瓣跨瓣收缩期压差分别为90 mmHg、110 mmHg和55 mmHg。主动脉收缩压分别为90 mmHg和110 mmHg。使压力下降50%的起搏频率分别为每分钟170次、250次和220次。所有患者的起搏时间均为15秒。所有病例在球囊充盈时均实现了球囊稳定，球囊无移动。球囊扩张后的压差分别为23 mmHg、28 mmHg和15 mmHg。球囊扩张后进行的血管造影显示，与球囊扩张前主动脉血管造影相比无变化：第一例有轻度主动脉瓣反流，第二例和第三例无主动脉瓣反流。
在球囊主动脉瓣成形术中进行快速心室起搏以稳定球囊似乎是安全有效的，并且可能降低主动脉瓣反流的发生率。
