Estrada Amara, Moïse N Sydney, Erb Hollis N, McDonough Sean P, Renaud-Farrell Shari
Section of Cardiology, Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
J Vet Intern Med. 2006 Jul-Aug;20(4):862-72. doi: 10.1892/0891-6640(2006)20[862:peotbr]2.0.co;2.
In dogs, treatment of pulmonic valve stenosis (PS) with pulmonary balloon valvuloplasty (PBV) is a viable method to decrease the pressure gradient across the valve. However, to the authors' knowledge, the variables that influence the selection of the correct balloon size for the procedure have not been explored. Moreover, the lesions caused by the procedure have not been detailed.
Variables that influence the measurement of the annulus could affect selection of the balloon size. We sought to determine the effects of treatment when the balloon-to-annulus ratio (BAR) was or > 1.3, but within the recommended range of 1.2-1.5, regardless of whether dilation was performed with single or double balloon technique.
Twenty-five Beagles with PS were studied.
Inter- and intra-observer variability, echocardiography versus angiocardiography, and systolic versus diastolic timing were evaluated for the BAR. Assessment of right ventricular (RV) pressure, Doppler gradient, stenotic valve area, and RV wall thickness were compared before and 1, 90, and 180 days after treatment. Postmortem examination of the heart was done.
Significant correlations existed in measurement of the annulus; however, variation existed that would change balloon size. Improvement in the degree of PS was significant regardless of the BAR or single or double ballooning. In the most severely affected dogs, continued improvement was noted on day 90. Postmortem examination revealed tears in the commissures and the valve leaflets.
Multiple factors influenced determination of the BAR and a range of 1.2-1.5 was effective without detrimental consequences. Dogs with severe PS had continued decrease in RV pressure 3 months after treatment.
在犬类中，采用肺动脉球囊瓣膜成形术（PBV）治疗肺动脉瓣狭窄（PS）是降低瓣膜跨瓣压力阶差的一种可行方法。然而，据作者所知，尚未探讨影响该手术正确球囊尺寸选择的变量。此外，该手术造成的病变也未详细描述。
影响瓣环测量的变量可能会影响球囊尺寸的选择。我们试图确定当球囊与瓣环比值（BAR）为或>1.3，但在推荐范围1.2 - 1.5内时，无论采用单球囊还是双球囊技术进行扩张，治疗的效果如何。
对25只患有PS的比格犬进行了研究。
评估了BAR的观察者间和观察者内变异性、超声心动图与心血管造影以及收缩期与舒张期时机。比较了治疗前以及治疗后1天、90天和180天的右心室（RV）压力、多普勒压力阶差、狭窄瓣膜面积和RV壁厚度。对心脏进行了尸检。
瓣环测量存在显著相关性；然而，存在会改变球囊尺寸的变化。无论BAR如何以及采用单球囊还是双球囊扩张，PS程度均有显著改善。在受影响最严重的犬只中，90天时仍有持续改善。尸检显示瓣叶连合处和瓣膜小叶有撕裂。
多种因素影响BAR的确定，1.2 - 1.5的范围是有效的且无不良后果。患有严重PS的犬只在治疗后3个月RV压力持续下降。
