Choi Eun Young, Song Jinyoung, Lee Heirim, Lee Chang Ha, Huh Jun, Kang I-Seok, Yang Ji Hyuk, Jun Tae Gook
Department of Pediatrics, Sejong General Hospital, Bucheon, Korea.
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Congenit Heart Dis. 2017 Dec;12(6):746-750. doi: 10.1111/chd.12507. Epub 2017 Jun 23.
Balloon dilatation of a bioprosthetic valve in the pulmonary position could be performed to delay valve replacement. We proposed to identify the long-term effectiveness of such a procedure.
We reviewed the medical records of 49 patients who underwent balloon valvuloplasty between January 2000 and December 2015. The primary goal was to determine the time interval until the following surgical or catheter intervention.
The mean age at bioprosthetic valve insertion was 5.7 years old, and the mean age for ballooning was 11.7 years. The mean interval after pulmonary valve replacement was 71.6 months. The mean ratio of balloon size to valve size was 0.94. The pressure gradient through the pulmonary valve after balloon valvuloplasty was significantly improved (55.3 ± 18.5 mm Hg vs 33.8 ± 21.5 mm Hg, P < .001). There were no significant changes in pulmonary regurgitation and no serious adverse events. Patients had a mean freedom from re-intervention of 30.6 months after balloon valvuloplasty. The interval of freedom from re-intervention was affected only by the pressure gradient before balloon valvuloplasty and the patient age at insertion. The mean interval to re-intervention in patients with pressure gradients less than 48.5 mm Hg before ballooning was 46.0 months, which was significantly longer than for those with a higher gradient (18.7 months).
The effectiveness of this process may depend on the pressure gradient before ballooning and the patient age at valve insertion. It is possible that earlier valvuloplasty at pressure gradient not over 48.5mm Hg may have a benefit to delaying re-operation.
对肺动脉位置的生物瓣膜进行球囊扩张术可延迟瓣膜置换。我们旨在确定该手术的长期疗效。
我们回顾了2000年1月至2015年12月期间接受球囊瓣膜成形术的49例患者的病历。主要目标是确定直至进行后续手术或导管介入的时间间隔。
生物瓣膜植入时的平均年龄为5.7岁，球囊扩张时的平均年龄为11.7岁。肺动脉瓣置换后的平均间隔时间为71.6个月。球囊大小与瓣膜大小的平均比值为0.94。球囊瓣膜成形术后通过肺动脉瓣的压力阶差显著改善（55.3±18.5 mmHg对33.8±21.5 mmHg，P<0.001）。肺动脉反流无显著变化，也无严重不良事件。球囊瓣膜成形术后患者再次干预的平均自由时间为30.6个月。再次干预的自由间隔仅受球囊瓣膜成形术前的压力阶差和植入时患者年龄的影响。球囊扩张术前压力阶差小于48.5 mmHg的患者再次干预的平均间隔时间为46.0个月，显著长于压力阶差较高的患者（18.7个月）。
该手术的疗效可能取决于球囊扩张术前的压力阶差和瓣膜植入时的患者年龄。在压力阶差不超过48.5 mmHg时尽早进行瓣膜成形术可能有助于延迟再次手术。
