Ensing G J, Hagler D J, Seward J B, Julsrud P R, Mair D D
Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota 55905.
J Am Coll Cardiol. 1989 Aug;14(2):397-400. doi: 10.1016/0735-1097(89)90192-7.
The results and complications of percutaneous balloon dilation involving 10 patients with a stenotic right ventricle to pulmonary artery prosthetic conduit and 1 patient with an obstructed right atrium to left pulmonary artery Dacron graft (modified Fontan) are reported. For the 10 patients (14.5 +/- 5 years) with a right ventricle to pulmonary artery conduit, the mean (+/- SD) predilation conduit valve gradient was 57 +/- 22 mm Hg, right ventricular pressure 104 +/- 21 mm Hg and right ventricle to pulmonary artery gradient 75 +/- 23 mm Hg; 2 of the patients had additional pulmonary artery stenosis requiring dilation. In one patient, the balloon could not be advanced across the conduit valve. In 9 of 10 patients in whom dilation was successfully performed, the conduit valve gradient decreased by 59 +/- 13%, right ventricle to pulmonary artery gradient by 43 +/- 22% and right ventricular pressure by 31 +/- 11%. After dilation, right ventricular pressure was less than 65% of systemic pressure in seven patients, although no pressure was less than 40%. In 8 of the 11 patients, surgery was avoided or postponed. Complications included loss of a balloon fragment after rupture during the unsuccessful dilation of the right atrium to left pulmonary artery graft and circumferential balloon rupture requiring catheter retrieval of the distal portion of the balloon from the femoral vein after successful dilation of the right ventricle to pulmonary artery conduit. Conduit valve dilation by balloon can reduce but rarely eliminate conduit obstruction, and balloon rupture may occur and can result in fragment loss or embolization.
本文报告了10例右心室至肺动脉人工管道狭窄患者及1例右心房至左肺动脉涤纶移植管（改良Fontan手术）梗阻患者接受经皮球囊扩张术的结果及并发症。对于10例（年龄14.5±5岁）右心室至肺动脉管道患者，扩张前管道瓣膜平均压差为57±22mmHg，右心室压力为104±21mmHg，右心室至肺动脉压差为75±23mmHg；其中2例患者合并肺动脉狭窄需行扩张术。1例患者球囊无法通过管道瓣膜。10例成功进行扩张术的患者中，9例患者的管道瓣膜压差下降了59±13%，右心室至肺动脉压差下降了43±22%，右心室压力下降了31±11%。扩张术后，7例患者的右心室压力低于体循环压力的65%，但无一例低于40%。11例患者中有8例避免了手术或推迟了手术。并发症包括右心房至左肺动脉移植管扩张失败时球囊破裂后球囊碎片丢失，以及右心室至肺动脉管道扩张成功后球囊周向破裂，需经导管从股静脉取出球囊远端部分。球囊扩张管道瓣膜可减轻但很少能消除管道梗阻，且可能发生球囊破裂，导致碎片丢失或栓塞。
