Voelker W, Seboldt H, Michel J, Fenchel G, Mauser M, Hoffmeister H M, Karsch K R
Department of Cardiology, Eberhard Karls University, Tuebingen, Germany.
Am Heart J. 1991 Nov;122(5):1327-33. doi: 10.1016/0002-8703(91)90573-z.
In selected patients with calcific aortic stenosis, balloon valvuloplasty is an intermediate alternative to surgery. The effect of balloon valvuloplasty to increase valve area, however, is limited and the restenosis rate is high during follow-up. To improve the results and reduce the complication rate, a new device for valvuloplasty of calcific aortic stenosis was developed. This system consists of three expandable prongs mounted on a freely movable catheter tip. To evaluate the efficacy of this new device, valvuloplasty was performed in 10 patients with severe aortic stenosis intraoperatively just prior to valve replacement. Comparison was made with the results of conventional balloon dilatation performed in an additional 20 patients during surgery. Using the new device, the relative orifice area increased from 10 +/- 3% before to 20 +/- 6% following intervention. However, in only one patient was a considerable increase of static valve area (greater than 15%) found. The results were comparable to the effect of conventional balloon dilatation, which led to an increase of orifice area from 12 +/- 7% to 24 +/- 10%. With both systems, the best results were achieved in patients with aortic stenosis and significant commissural fusion. In contrast, in bicuspid or tricuspid valves without fused commissures the effect of the intervention was limited. Because complete obstruction of the aortic valve does not occur during dilatation, this new device might be superior to conventional balloon dilatation. Preselection of patients according to the morphology of the valve seems mandatory to improve the success and reduce the complication rate of valvuloplasty in aortic stenosis.
在部分钙化性主动脉瓣狭窄患者中，球囊瓣膜成形术是手术的一种中间替代方案。然而，球囊瓣膜成形术增加瓣膜面积的效果有限，且随访期间再狭窄率较高。为了改善治疗效果并降低并发症发生率，研发了一种用于钙化性主动脉瓣狭窄瓣膜成形术的新装置。该系统由安装在可自由移动导管尖端的三个可扩张叉形物组成。为评估这种新装置的疗效，在10例严重主动脉瓣狭窄患者瓣膜置换术前术中进行了瓣膜成形术。并与另外20例手术期间进行传统球囊扩张的患者结果进行了比较。使用新装置，相对开口面积从干预前的10±3%增加到干预后的20±6%。然而，仅在1例患者中发现静态瓣膜面积有显著增加（大于15%）。结果与传统球囊扩张的效果相当，传统球囊扩张使开口面积从12±7%增加到24±10%。对于这两种系统，在伴有明显瓣叶融合的主动脉瓣狭窄患者中取得了最佳效果。相比之下，在没有融合瓣叶的二叶式或三叶式瓣膜中，干预效果有限。由于扩张过程中不会出现主动脉瓣完全梗阻，这种新装置可能优于传统球囊扩张。根据瓣膜形态对患者进行预选似乎是提高主动脉瓣狭窄瓣膜成形术成功率和降低并发症发生率的必要条件。
