Thapar M K, Rao P S
Department of Pediatrics, King Faisal Specialist Hospital, Riyadh.
Am Heart J. 1989 Jul;118(1):99-103. doi: 10.1016/0002-8703(89)90078-1.
This study was designed to define the prevalence and significance of infundibular obstruction following balloon pulmonary valvuloplasty. Thirteen of 62 children had infundibular gradients prior to valvuloplasty; five of these disappeared following balloon valvuloplasty. Five other children without pre-valvuloplasty infundibular gradients but with angiographic infundibular narrowing developed new infundibular gradients following valvuloplasty. Propranolol was administered to six children because of severe infundibular constriction, with improvement. None required surgical intervention. At follow-up the infundibular gradients either diminished or disappeared. The infundibular gradients appear to be more frequent with increasing age and severity of pulmonary valvar obstruction. Children developing systemic or suprasystemic right ventricular pressures after balloon pulmonary valvuloplasty may be candidates for propranolol therapy. Regression of the infundibular stenosis at follow-up can be expected, as has been observed after surgical pulmonary valvotomy. Because the infundibular obstruction can be successfully managed, balloon pulmonary valvuloplasty remains the treatment of choice for isolated valvar pulmonary stenosis. Use of balloon valvuloplasty in children less than 5 years of age and/or prior to development of pulmonary gradients in excess of 80 mm Hg may reduce the chance for development of infundibular reaction.
本研究旨在明确球囊肺动脉瓣成形术后漏斗部梗阻的发生率及其意义。62例儿童中，13例在瓣膜成形术前存在漏斗部压力阶差；其中5例在球囊瓣膜成形术后压力阶差消失。另外5例在瓣膜成形术前无漏斗部压力阶差但血管造影显示漏斗部狭窄的儿童，在瓣膜成形术后出现了新的漏斗部压力阶差。6例因严重漏斗部狭窄给予普萘洛尔治疗，症状改善。无一例需要手术干预。随访时，漏斗部压力阶差减小或消失。漏斗部压力阶差似乎随年龄增长和肺动脉瓣梗阻严重程度增加而更常见。球囊肺动脉瓣成形术后出现体循环或超体循环右心室压力的儿童可能是普萘洛尔治疗的候选者。正如手术肺动脉瓣切开术后所观察到的，随访时漏斗部狭窄可预期会消退。由于漏斗部梗阻可得到成功处理，球囊肺动脉瓣成形术仍然是单纯瓣膜性肺动脉狭窄的首选治疗方法。在5岁以下儿童和/或肺动脉压力阶差超过80 mmHg之前使用球囊瓣膜成形术可能会降低漏斗部反应发生的几率。
