Guarnera S, Piechaud J F, Kachaner J, Le Bidois J, Cohen L, Sidi D, Villain E
Département de Pédiatrie, Hôpital Necker-Enfants-Malades, Paris.
Arch Fr Pediatr. 1989 Aug-Sep;46(7):503-8.
Twenty-eight neonates aged 1 to 21 days with critical pulmonic stenosis were treated by percutaneous valvotomy consisting of balloon dilatation of the stenotic valve by percutaneous catheterization. The right ventricular systolic pressure (RVP) was either the same or higher than the systemic pressure in all cases but 3. In those it was somewhat lower (80%) than the left ventricular systolic pressure (LVP) so that, on the whole, the RVP/LVP ratio, here called rP ranged from 0.8 to 2 (m = 1.41 +/- 0.36). The procedure failed 5 times because of failure to introduce the balloon through the valve (4 cases) or because of an accident (1 case). All failures occurred during the initial phase of our experience with this procedure as the last 20 trials were successful. The procedure was inefficacious in 3 cases (13%) but immediately successful in the other 20 (87%) with a drop in the mean rP to 0.59 +/- 0.17. During the follow-up period, one neonate continued to present with an important degree of cyanosis, due to a poor right ventricular compliance. He had to be operated on. Pulmonic stenosis reappeared in 6 cases who underwent for a second time a percutaneous valvotomy. The procedure was successful in 3 and failed in 3 who eventually required surgery. Overall, the satisfactory results observed after the procedure persisted over time in 13 cases. In conclusion, interventional catheterization has become almost always possible in neonates with critical pulmonic stenosis. If performed under vigorously controlled conditions including an infusion of prostaglandin E1 in cases with severe cyanosis and the use of large diameter balloons, this method is relatively safe and generally efficacious since in 70% of cases it circumvents the need for surgery.
28例年龄在1至21天的患有严重肺动脉瓣狭窄的新生儿接受了经皮瓣膜切开术，该手术通过经皮导管对狭窄瓣膜进行球囊扩张。除3例病例外，所有病例的右心室收缩压（RVP）均与体循环压力相同或更高。在这3例中，RVP略低于左心室收缩压（LVP）（80%），因此总体而言，此处称为rP的RVP/LVP比值范围为0.8至2（平均值=1.41±0.36）。该手术失败了5次，原因是未能将球囊通过瓣膜（4例）或由于意外情况（1例）。所有失败均发生在我们开展该手术的初期阶段，因为最近的20次尝试均成功。该手术在3例病例中无效（13%），但在其他20例中立即成功（87%），平均rP降至0.59±0.17。在随访期间，1例新生儿由于右心室顺应性差，持续存在严重的紫绀，不得不接受手术治疗。6例接受了第二次经皮瓣膜切开术的病例中，肺动脉瓣狭窄复发。该手术在3例中成功，3例失败，最终均需要手术治疗。总体而言，13例病例术后观察到的满意结果随时间持续存在。总之，对于患有严重肺动脉瓣狭窄的新生儿，介入性导管插入术几乎总是可行的。如果在严格控制的条件下进行，包括在严重紫绀病例中输注前列腺素E1以及使用大直径球囊，该方法相对安全且通常有效，因为70%的病例无需进行手术。
