Florenzano F, Uriarte P, Meruane J, Kauffmann R
Rev Med Chil. 1989 Jul;117(7):755-60.
Symptomatic calcific aortic stenosis in elderly patients has a poor prognosis and a relatively high surgical risk. Percutaneous aortic valvuloplasty is a new therapeutic procedure that may be applied in this group of patients. We report immediate results obtained with this technique in a cooperative study of 3 hospitals. In 16 of 19 patients we were able to locate a balloon catheter across the aortic valve following a femoral artery puncture. Mean age was 72 years and almost all patients were considered high surgical risk. Peak aortic gradient fell from 89 + 33 to 47 + 21 mmHg while valve area rose from 0.43 + 0.14 to 0.66 + 0.27 cm2; cardiac output remained unchanged. In 5 patients, an aortic valve area above 0.7 cm2 was obtained. Four patients needed blood transfusion, one developed pericardial tamponade and other recovered uneventfully from ventricular fibrillation. One patient died hours after the procedure in a low output state probably related to aortic insufficiency. We feel that aortic valvuloplasty is indicated in patients with severe calcific aortic stenosis and high surgical risk. Moderate improvement can be obtained with risks commensurate with the severity of the illness.
老年有症状的钙化性主动脉瓣狭窄患者预后较差，手术风险相对较高。经皮主动脉瓣成形术是一种可应用于这类患者的新治疗方法。我们报告了在3家医院合作开展的一项研究中采用该技术所获得的即时结果。19例患者中有16例在股动脉穿刺后能够将球囊导管置于主动脉瓣处。平均年龄为72岁，几乎所有患者均被视为手术高风险患者。主动脉峰值压差从89±33 mmHg降至47±21 mmHg，而瓣膜面积从0.43±0.14 cm²增至0.66±0.27 cm²；心输出量保持不变。5例患者获得了大于0.7 cm²的主动脉瓣面积。4例患者需要输血，1例发生心包填塞，另1例从室颤中顺利恢复。1例患者在术后数小时死于低心排血量状态，可能与主动脉瓣关闭不全有关。我们认为，经皮主动脉瓣成形术适用于重度钙化性主动脉瓣狭窄且手术风险高的患者。可获得中度改善，风险与疾病严重程度相当。
