Maxwell D, Allan L, Tynan M J
Department of Fetal Medicine, Guy's Hospital, London.
Br Heart J. 1991 May;65(5):256-8. doi: 10.1136/hrt.65.5.256.
Because they had irreversible damage to the left ventricular myocardium none of 12 patients with critical aortic stenosis diagnosed prenatally survived after postnatal treatment. This experience prompted three attempts at intrauterine balloon dilatation of the aortic valve in two fetuses with this condition. On each attempt the balloon catheter was successfully delivered to the left ventricle. In the first fetus the aortic valve was not crossed and the fetus died the next day. In the second fetus the balloon was correctly positioned across the aortic valve and inflated in the valve ring. After delivery, a further balloon angioplasty was performed; this relieved the stenosis but the patient died five weeks later from persisting left ventricular dysfunction related to endocardial fibroelastosis. Balloon angioplasty is feasible in fetal life but the prognosis depends on the ability of the relief of stenosis to limit, prevent, or allow regression of left ventricular damage before delivery.
由于12例产前诊断为严重主动脉瓣狭窄的患者左心室心肌均有不可逆损伤，产后治疗后无一存活。这一情况促使对2例患有该病症的胎儿进行了3次宫内主动脉瓣球囊扩张尝试。每次尝试时，球囊导管均成功送达左心室。在第一例胎儿中，未穿过主动脉瓣，胎儿于次日死亡。在第二例胎儿中，球囊正确置于主动脉瓣上并在瓣环处充气。分娩后，又进行了一次球囊血管成形术；这缓解了狭窄，但患者在五周后死于与心内膜弹力纤维增生症相关的持续性左心室功能障碍。球囊血管成形术在胎儿期是可行的，但预后取决于在分娩前缓解狭窄以限制、预防或使左心室损伤消退的能力。
