Sreeram N, Saleem M, Jackson M, Peart I, McKay R, Arnold R, Walsh K
Department of Cardiology, Royal Liverpool Children's Hospital, England.
J Am Coll Cardiol. 1991 Jul;18(1):159-65. doi: 10.1016/s0735-1097(10)80235-9.
Balloon pulmonary valvuloplasty was attempted in 67 patients with tetralogy of Fallot at a median age of 5 months (range 0.03 to 52 months) for relief of cyanosis. In three patients, the valve could not be crossed and an aortopulmonary shunt was performed. In 35 patients, follow-up angiography was performed 3 to 30 months (average 12) after valvuloplasty. In 24 of these 35 patients (group A), the stenosis had been adequately palliated by valvuloplasty; the other 11 patients (group B) had required an aortopulmonary shunt 1 month (range 0 to 3 months) after valvuloplasty. The two groups were similar (p greater than 0.1) with respect to age at valvuloplasty, pulmonary anulus diameter, ratio of pulmonary artery to descending aorta diameter before valvuloplasty and interval to follow-up angiography. In contrast to patients in group B, patients in group A had a significant immediate improvement in systemic arterial oxygen saturation (p less than 0.01) and a significant increase in pulmonary anulus diameter at follow-up angiography (p less than 0.001). The growth of the branch pulmonary arteries was similar (p greater than 0.1) in the two groups. Among 42 patients who have had surgical correction, a transannular patch for right ventricular outflow tract reconstruction was used in 27 (64%); there was no difference between groups A and B with respect to its use. Eight patients died (three after repair) and death could not be directly attributed to valvuloplasty in any. Balloon valvuloplasty promotes growth of the pulmonary valve anulus and pulmonary arteries and is a useful alternative to an aortopulmonary shunt in patients with small pulmonary arteries or associated complex intracardiac defects.
对67例法洛四联症患者进行了球囊肺动脉瓣成形术，这些患者的中位年龄为5个月（范围0.03至52个月），目的是缓解紫绀。3例患者瓣膜未能通过，遂进行了体肺分流术。35例患者在瓣膜成形术后3至30个月（平均12个月）进行了随访血管造影。在这35例患者中的24例（A组），瓣膜成形术已充分缓解了狭窄；另外11例患者（B组）在瓣膜成形术后1个月（范围0至3个月）需要进行体肺分流术。两组在瓣膜成形术时的年龄、肺动脉环直径、瓣膜成形术前肺动脉与降主动脉直径之比以及随访血管造影的间隔时间方面相似（p大于0.1）。与B组患者相比，A组患者的体循环动脉血氧饱和度有显著的即刻改善（p小于0.01），且随访血管造影时肺动脉环直径有显著增加（p小于0.001）。两组肺分支动脉的生长情况相似（p大于0.1）。在42例接受手术矫正的患者中，27例（64%）使用了跨环补片进行右心室流出道重建；A组和B组在其使用方面无差异。8例患者死亡（3例在修复后），且死亡均不能直接归因于瓣膜成形术。球囊瓣膜成形术可促进肺动脉瓣环和肺动脉的生长，对于肺动脉细小或合并复杂心内缺损的患者而言，是体肺分流术的一种有用替代方法。
