Kim Geena, Ban Gil Ho, Lee Hyoung Doo, Sung Si Chan, Kim Hyungtae, Choi Kwang Ho
Heart Center, Pusan National University Children's Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Congenit Heart Dis. 2016 Jul;11(4):315-22. doi: 10.1111/chd.12388. Epub 2016 Jul 6.
We investigated the effect of balloon pulmonary valvuloplasty (BPV) as a palliative procedure for patients with tetralogy of Fallot (TOF).
This was a retrospective single-center study conducted between 2008 and 2014. We classified patients into three groups according to palliation: treatment with BPV (group I), with a Blalock-Taussig shunt (group II), and with infundibulectomy (group III). The growth of the pulmonary valve (PV) annulus and need for transannular patching (TAP) during total correction were compared between groups.
Forty-eight patients were enrolled: 31, 10, and 7 in groups I, II, and III, respectively. The mean ages at palliation were 26.3 ± 23.6, 21.5 ± 16.4, and 15.2 ± 4.2 days in groups I, II, and III, respectively (P = .867). The success rate of BPV was 90.3%. The initial PV z-score before palliation did not differ between groups I, II, and III (-3.14 ± 1.44, -3.84 ± 1.47, and -3.71 ± 1.68; P = .494); the preoperative PV z-score before total correction was larger in group I than in group II (-1.19 ± 1.14 and -3.05 ± 1.19; P = .001), and also larger in group III than in group II (group III: -1.10 ± 0.90; P = .003). The change in pulse oxygen saturation differed significantly between the three groups (P = .031), particularly between groups I and II (P = .010), and the change in PV z-score was greater in groups I and III than in group II (P < .001). TAP during total correction was performed in 29.0%, 90.0%, and 16.7% of groups I, II, and III, respectively (P = .001; group I vs. II, P = .001; group II vs. III, P = .008).
BPV was an effective and safe palliation that increased pulmonary blood flow and promoted growth of the PV annulus in selected symptomatic newborns with TOF.
我们研究了球囊肺动脉瓣成形术（BPV）作为法洛四联症（TOF）患者姑息治疗方法的效果。
这是一项于2008年至2014年进行的回顾性单中心研究。我们根据姑息治疗方法将患者分为三组：接受BPV治疗的患者（第一组）、接受Blalock-Taussig分流术的患者（第二组）和接受漏斗部切除术的患者（第三组）。比较了三组患者在完全矫正期间肺动脉瓣（PV）环的生长情况以及经环补片（TAP）的需求。
共纳入48例患者，第一组、第二组和第三组分别有31例、10例和7例。第一组、第二组和第三组患者进行姑息治疗时的平均年龄分别为26.3±23.6天、21.5±16.4天和15.2±4.2天（P = 0.867）。BPV的成功率为90.3%。三组患者姑息治疗前的初始PV z评分无差异（-3.14±1.44、-3.84±1.47和-3.71±1.68；P = 0.494）；完全矫正术前第一组的PV z评分高于第二组（-1.19±1.14和-3.05±1.19；P = 0.001），第三组也高于第二组（第三组：-1.10±0.90；P = 0.003）。三组患者的脉搏血氧饱和度变化有显著差异（P = 0.031），尤其是第一组和第二组之间（P = 0.010），第一组和第三组的PV z评分变化大于第二组（P < 0.001）。第一组、第二组和第三组在完全矫正期间分别有29.0%、90.0%和16.7%的患者进行了TAP（P = 0.001；第一组与第二组比较，P = 0.001；第二组与第三组比较，P = 0.008）。
对于有症状的TOF新生儿，BPV是一种有效且安全的姑息治疗方法，可增加肺血流量并促进PV环的生长。
