Bingler Michael A, Darst Jeffrey R, Fagan Thomas E
Children's Mercy Hospital, Kansas City, MO, USA.
Pediatr Cardiol. 2012 Jan;33(1):109-14. doi: 10.1007/s00246-011-0099-1. Epub 2011 Sep 3.
This study sought to determine the safety and effectiveness of cryo-balloon angioplasty (CbA) for pulmonary vein stenosis (PVS) in pediatric patients. Current therapy options for PVS are less than satisfactory due to recurrent progressive restenosis and neointimal proliferation. Catheterization database, hospital records, imaging studies, and pathologic specimens were reviewed for procedural-related and outcomes data in all patients who underwent pulmonary vein (PV) CbA using the Boston Scientific PolarCath Peripheral Dilation System between August 2006 and June 2009. Thirteen patients (19 PVs; median age 13 months [range 3.5 months to 18.5 years] and weight 7.9 kg [range 3.8 to 47.7]) underwent CbA. Mean PVS diameter after CbA increased from 2.19 (± 0.6) to 3.77 (± 1.1) mm (p < 0.001). Mean gradient decreased from 14 (± 7.4) to 4.89 (± 3.2) mm Hg (p < 0.001). Mean stenosis-to-normal vein diameter ratio increased from 0.52 (± 0.15) to 0.89 (± 0.33) (p < 0.001). Eight patients underwent repeat catheterization a mean of 5.6 months (± 3.66) later. Improved PVS diameter was maintained in 2 PVs. Four veins had restenosis but maintained diameters greater than that before initial CbA. In 11 PVs, the diameter decreased from 4.28 (± 1.14) to 2.53 (± 0.9) mm (p = 0.001). Mean gradient increased from 3.55 (± 3.0) to 14.63 (± 9.6) mm Hg (p = 0.011). All vessels underwent repeat intervention with acute relief of PVS. Stroke occurred within 24 h of CbA in 1 patient. CbA of PVS is safe and results in acute relief of stenosis. However, CbA appears minimally effective as the sole therapy in maintaining long-term relief of PVS.
本研究旨在确定冷冻球囊血管成形术（CbA）治疗小儿患者肺静脉狭窄（PVS）的安全性和有效性。由于复发性进行性再狭窄和新生内膜增生，目前PVS的治疗选择并不理想。回顾了2006年8月至2009年6月期间所有使用波士顿科学公司的PolarCath外周扩张系统接受肺静脉（PV）CbA治疗的患者的导管插入术数据库、医院记录、影像学研究和病理标本，以获取与手术相关的信息和结果数据。13例患者（19条PV；中位年龄13个月[范围3.5个月至18.5岁]，体重7.9 kg[范围3.8至47.7 kg]）接受了CbA治疗。CbA术后PV平均直径从2.19（±0.6）mm增加至3.77（±1.1）mm（p<0.001）。平均压差从14（±7.4）mmHg降至4.89（±3.2）mmHg（p<0.001）。平均狭窄与正常静脉直径之比从0.52（±0.15）增加至0.89（±0.33）（p<0.001）。8例患者在平均5.6个月（±3.66）后接受了再次导管插入术。2条PV维持了改善后的直径。4条静脉出现再狭窄，但维持的直径大于初次CbA前。11条PV的直径从4.28（±1.14）mm降至2.53（±0.9）mm（p=0.001）。平均压差从3.55（±3.0）mmHg增至14.63（±9.6）mmHg（p=0.011）。所有血管均接受了再次干预，PVS得到急性缓解。1例患者在CbA术后24小时内发生中风。PVS的CbA是安全的，可导致狭窄的急性缓解。然而，作为维持PVS长期缓解的唯一疗法，CbA似乎效果甚微。
