Zeevi B, Keane J F, Perry S B, Lock J E
Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115.
J Am Coll Cardiol. 1989 Aug;14(2):401-8; discussion 409-12. doi: 10.1016/0735-1097(89)90193-9.
Balloon dilation was attempted in 16 patients, aged 5 months to 19.5 years, with right ventricular outflow obstruction after repair of congenital heart defects. Stenosis of a valved conduit between the pulmonary ventricle and pulmonary artery was present in nine patients with a mean transvalvular peak systolic ejection gradient of 61.6 +/- 21.0 mm Hg and a mean right ventricle to aorta pressure ratio of 0.9 +/- 0.2. Supravalvular pulmonary stenosis was present in seven patients; in five, stenosis was at the anastomotic site after the arterial switch operation with a mean peak systolic ejection gradient of 72.2 +/- 10.6 mm Hg and mean right ventricle to aorta pressure ratio of 0.93 +/- 0.05. The other two patients had stenosis at a previous pulmonary artery band site with a peak systolic ejection gradient of 60 and 65 mm Hg and right ventricle to aorta pressure ratio of 0.75 and 0.72, respectively. Balloon dilation was successful in three of nine patients with a valved conduit; two of them had additional successful balloon dilation of the right pulmonary artery. In five of the nine patients (including one with successful dilation) the conduit was replaced 5.7 +/- 4.5 months after balloon dilation. Balloon dilation was successful in only one of the five patients with supravalvular pulmonary stenosis after the arterial switch operation and partially successful in the two patients with supravalvular pulmonary stenosis at a previous band site. The success rate of balloon dilation of postoperative right ventricular outflow obstruction is much lower than that for other right heart obstructions.
对16例年龄在5个月至19.5岁之间、先天性心脏缺陷修复后出现右心室流出道梗阻的患者进行了球囊扩张术。9例患者存在肺动脉心室与肺动脉之间带瓣管道狭窄，平均跨瓣收缩期峰值射血梯度为61.6±21.0 mmHg，右心室与主动脉压力比平均为0.9±0.2。7例患者存在肺动脉瓣上狭窄；5例在动脉调转术后吻合部位出现狭窄，平均收缩期峰值射血梯度为72.2±10.6 mmHg，右心室与主动脉压力比平均为0.93±0.05。另外2例患者在先前肺动脉束带部位出现狭窄，收缩期峰值射血梯度分别为60和65 mmHg，右心室与主动脉压力比分别为0.75和0.72。9例带瓣管道患者中有3例球囊扩张成功；其中2例右肺动脉球囊扩张也成功。9例患者中有5例（包括1例扩张成功的患者）在球囊扩张后5.7±4.5个月更换了管道。动脉调转术后5例肺动脉瓣上狭窄患者中仅1例球囊扩张成功，2例先前束带部位肺动脉瓣上狭窄患者球囊扩张部分成功。术后右心室流出道梗阻球囊扩张的成功率远低于其他右心梗阻。
