Akdeniz Celal, Erdem Abdullah, Demir Fadli, Sarıtaş Türkay, Zeybek Cenap, Demir Halil, Yalçın Yalım, Celebi Ahmet
Dr. Siyami Ersek Göğüs Kalp ve Damar Cerrahisi Eğitim ve Araştırma Hastanesi, Pediyatrik Kardiyoloji Kliniği, İstanbul, Türkiye.
Anadolu Kardiyol Derg. 2011 Jun;11(4):329-35. doi: 10.5152/akd.2011.084. Epub 2011 May 11.
The objective of this study was to assess medium-term results of aortic balloon valvuloplasty (ABV) in congenital aortic stenosis and to determine factors affecting development of aortic regurgitation (AR).
Between September 2003 and January 2010, 114 ABV procedures performed on 97 patients analyzed retrospectively. Patients were evaluated in terms of transvalvular gradients before and after procedure, development of new aortic insufficiency or increase in the current insufficiency and factors affecting the procedural success and development of aortic insufficiency. In addition, follow up results were also evaluated in terms of restenosis and increase or decrease of aortic regurgitation. Student's t-test, ANOVA for repeated measurements, linear discriminant and Kaplan-Meier survival analyses were used for statistical analysis.
The mean age was 6.63±6.33 year (2 days-21 years). Mean follow-up was 32.6±25.1 months (1 to 75 months). Thirty-seven patients were infant (<1 year) and 18 of them were newborn. The peak systolic pressure gradient decreased from 77.2±24.9 mmHg to 28.5±12.9 mmHg (p=0.0001). Eighty-two procedures were optimal, 29 suboptimal and 3 were unsuccessful. AR developed in totally 53 patients, 16 of them were significant degree. Balloon /annulus ratio and the percentage of reduction in gradient was meaningfully higher in patients with significant aortic regurgitation (p=0.02 and p=0.03, respectively). Infants show more significant AR (9/37, 24%) in comparison with bigger patients (7/77, 9%) (p=0.02). Four patients died after procedure at intensive care unit, three of them were newborn.
ABV is safe and effective palliative method for the treatment of congenital aortic stenosis. AR, which was the most common complication, incidence was increased in infancy and was related with high balloon/annulus ratio and high reduction in gradient.
本研究旨在评估先天性主动脉瓣狭窄行主动脉球囊瓣膜成形术（ABV）的中期结果，并确定影响主动脉瓣反流（AR）发生的因素。
回顾性分析2003年9月至2010年1月期间对97例患者实施的114例ABV手术。对患者术前和术后的跨瓣压差、新出现的主动脉瓣关闭不全或现有关闭不全的加重情况以及影响手术成功和主动脉瓣关闭不全发生的因素进行评估。此外，还对再狭窄以及主动脉瓣反流的增加或减少方面的随访结果进行了评估。采用学生t检验、重复测量方差分析、线性判别分析和Kaplan-Meier生存分析进行统计分析。
平均年龄为6.63±6.33岁（2天至21岁）。平均随访时间为32.6±25.1个月（1至75个月）。37例患者为婴儿（<1岁），其中18例为新生儿。收缩期峰值压力梯度从77.2±24.9 mmHg降至28.5±12.9 mmHg（p = 0.0001）。82例手术效果最佳，29例次优，3例失败。共有53例患者发生AR，其中16例为重度。重度主动脉瓣反流患者的球囊/瓣环比值和压差降低百分比显著更高（分别为p = 0.02和p = 0.03）。与年龄较大的患者（7/77，9%）相比，婴儿发生AR的情况更显著（9/37，24%）（p = 0.02）。4例患者术后在重症监护病房死亡，其中3例为新生儿。
ABV是治疗先天性主动脉瓣狭窄安全有效的姑息方法。AR是最常见的并发症，其发生率在婴儿期增加，且与高球囊/瓣环比值和高压差降低有关。
