Scherer H E, Lindner K, Wosnoik W, Engel H J
Medizinische Klinik, Bereich Kardiologie, Zentralkrankenhaus Links der Weser Bremen.
Z Kardiol. 1990 Jul;79(7):489-98.
We analyzed the results and the follow-up in our first 80 patients after percutaneous balloon aortic valvuloplasty (BAV) since November 1986. Mean age was 74 +/- 10 years, 78 patients were in the NYHA functional classes III or IV. Initially we used relatively small balloons (15-18 mm), later balloons of 20 mm and, with increasing frequency, of 23 mm diameter were utilized, providing very strong inflations at the end of the procedure. The average valve area after BAV increased from initially 0.75 +/- 0.18 to 0.87 +/- 0.28 cm2 after July 1987. Using the 23-mm balloon a mean valve area of 1.05 +/- 0.19 cm2 was obtained. The procedure-related mortality was 2.5%, the total early mortality (30 days) was 6.25%. Other non-fatal complications included two cases of severe valve incompetence requiring valve replacement, one dissection in the aortic root, one cerebrovascular accident, and eight cases of arterial damage (surgical repair). Twenty-six patients with initially successful dilation were restudied hemodynamically, 12 of whom had a restenosis (46%) after 5 months; 13 patients had a second dilatation. The clinical improvement was remarkable (at least 1 NYHA functional class) in 79% of the patients. 33% were improved 1 year and 20% 18 months after the first or eventually the second BAV. Eighteen of the discharged patients died in the follow-up period (two after valve replacement); 20 patients had aortic valve replacement due to restenosis. Our results show a correlation of the maximal balloon size to the valve area after BAV. However, even a perfect technique cannot prevent the restenosis that occurs mostly during the first year. Therefore, BAV may be useful and appropriate for selected patients with inoperable aortic stenosis, but it is no alternative to valve replacement.
我们分析了自1986年11月以来接受经皮球囊主动脉瓣成形术（BAV）的首批80例患者的结果及随访情况。平均年龄为74±10岁，78例患者属于纽约心脏协会（NYHA）心功能Ⅲ或Ⅳ级。最初我们使用相对较小的球囊（15 - 18毫米），后来使用20毫米的球囊，且使用直径为23毫米球囊的频率逐渐增加，在操作结束时进行非常强力的充盈。BAV术后平均瓣口面积从最初的0.75±0.18平方厘米增加到1987年7月后的0.87±0.28平方厘米。使用23毫米球囊时，平均瓣口面积为1.05±0.19平方厘米。手术相关死亡率为2.5%，早期总死亡率（30天）为6.25%。其他非致命并发症包括2例严重瓣膜关闭不全需行瓣膜置换、1例主动脉根部夹层、1例脑血管意外以及8例动脉损伤（手术修复）。对26例最初扩张成功的患者进行了血流动力学复查，其中12例在5个月后出现再狭窄（46%）；13例患者进行了二次扩张。79%的患者临床症状显著改善（至少提升1个NYHA心功能级别）。首次或最终第二次BAV术后1年，33%的患者症状改善；18个月时，20%的患者症状改善。18例出院患者在随访期间死亡（2例在瓣膜置换后）；20例患者因再狭窄行主动脉瓣置换术。我们的结果显示BAV术后最大球囊尺寸与瓣口面积存在相关性。然而，即便技术完美也无法预防大多在第一年出现的再狭窄。因此，BAV对于某些无法手术的主动脉瓣狭窄患者可能有用且合适，但它无法替代瓣膜置换术。
