Sievert H, Krämer P, Kober G, Bussmann W D, Kaltenbach M
Department of Cardiology, University of Frankfurt, F.R.G.
Int J Cardiol. 1989 May;23(2):179-83. doi: 10.1016/0167-5273(89)90246-5.
Balloon dilatation of calcified aortic stenosis was attempted in 12 patients, 6 men and 6 women, aged 38-82 years. Two patients underwent emergency surgery because of myocardial injury or pericardial tamponade. One patient with severe depressed left ventricular function in whom the procedure was attempted in cardiogenic shock died during the procedure. One patient experienced severe aortic insufficiency after dilatation. The remaining pressure gradient was higher than 50 mm Hg in another patient. Seven dilatations were considered to be successful with a remaining pressure gradient below 50 mm Hg and a mean gradient reduction of 53 mm Hg. In one of these 7 patients, who suffered from severe heart failure, valvoplasty had been carried out to make aortic valve replacement possible. The operation was performed 2 weeks later without complications. Five of 6 patients treated medically after successful valvoplasty had restenosis within 3 to 12 months. One of them exhibited a good result at 3 months but severe restenosis after one year. It is concluded that balloon valvoplasty of calcified aortic stenosis cannot be considered an alternative to surgery. If, however, left ventricular function improves after successful valvoplasty, valve replacement will then carry less risk.
对12例年龄在38至82岁之间的患者（6例男性和6例女性）尝试进行钙化性主动脉瓣狭窄的球囊扩张术。2例患者因心肌损伤或心包填塞接受了急诊手术。1例左心室功能严重减退且在心源性休克状态下尝试该手术的患者在手术过程中死亡。1例患者在扩张术后出现严重主动脉瓣关闭不全。另1例患者术后残余压力阶差高于50 mmHg。7例扩张术被认为成功，残余压力阶差低于50 mmHg，平均阶差降低53 mmHg。在这7例患者中的1例，患有严重心力衰竭，已先行瓣膜成形术以便能够进行主动脉瓣置换术。手术在2周后进行，无并发症。6例在成功的瓣膜成形术后接受内科治疗的患者中有5例在3至12个月内出现再狭窄。其中1例在3个月时效果良好，但1年后出现严重再狭窄。结论是，钙化性主动脉瓣狭窄的球囊瓣膜成形术不能被视为手术的替代方法。然而，如果成功的瓣膜成形术后左心室功能改善，那么瓣膜置换术的风险将降低。
