Auld Benjamin, Carrigan Lindsay, Ward Cameron, Justo Robert, Alphonso Nelson, Anderson Ben
Queensland Paediatric Cardiac Service, Lady Cilento Children's Hospital, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
Queensland Paediatric Cardiac Service, Lady Cilento Children's Hospital, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
Heart Lung Circ. 2019 Apr;28(4):632-636. doi: 10.1016/j.hlc.2018.02.014. Epub 2018 Mar 1.
The approach to intervention for congenital aortic valve stenosis (AS) differs depending upon centre bias toward a primary catheter or surgical approach. We therefore investigated associations with freedom from re-intervention (FFI) in the cohort of children who underwent primary balloon aortic valvuloplasty (BAV) for congenital AS in our centre.
All patients who underwent BAV as a primary procedure in the period between 2001 and 2015 in a single service were included. Echocardiographic parameters before and after catheterisation and procedural data was collected on all patients.
Sixty-four (64) patients underwent BAV as the primary intervention during the study period. Follow-up data was available for 60 of these. Balloon aortic valvuloplasty was performed at a median age of 143 days (range 2 days-18.8 years). Freedom from re-intervention was observed in 75% of patients with a median follow-up of 6.8 years and a mean follow-up of 3 years. Catheter-based peak-to-peak aortic valve gradients decreased from 58±15.9mmHg to 22.9±13.1mmHg. There was no short- or long-term mortality. FFI was predicted by aortic valve morphology (p<0.01), post-BAV mean echo gradient (p=0.03) and post-BAV regurgitation (p<0.01). No patient had re-intervention for restenosis with post-BAV mean echo gradient <30mmHg. Catheter gradients before and after BAV approached significance for predicting FFI (p=0.06 and p=0.09 respectively). Fifteen (15) patients were neonates with significantly lower aortic valve (AoV) Z-scores (mean 0.63 vs 1.76, p=0.002) and no difference in FFI (p=0.19). Annulus size, balloon/annulus ratio (within the range utilised) and pre-BAV echo findings were not predictive for re-intervention.
Balloon aortic valvuloplasty is an effective primary approach to congenital valvular AS with the potential of avoiding surgical intervention in the majority of patients at all ages. Freedom from re-intervention in our cohort was associated with valve morphology and the degree of stenosis and regurgitation immediately post BAV.
对于先天性主动脉瓣狭窄（AS）的干预方法因各中心对主要采用导管介入或手术方法的偏好而有所不同。因此，我们在本中心对接受原发性球囊主动脉瓣成形术（BAV）治疗先天性AS的儿童队列中，研究了与免于再次干预（FFI）相关的因素。
纳入2001年至2015年期间在单一科室接受BAV作为主要治疗手段的所有患者。收集了所有患者导管插入术前和术后的超声心动图参数以及手术数据。
在研究期间，64例患者接受了BAV作为主要干预措施。其中60例有随访数据。球囊主动脉瓣成形术的实施中位年龄为143天（范围2天至18.8岁）。6.8年的中位随访期和3年的平均随访期内，75%的患者免于再次干预。基于导管的主动脉瓣峰-峰压差从58±15.9mmHg降至22.9±13.1mmHg。无短期或长期死亡情况。免于再次干预可通过主动脉瓣形态（p<0.01）、BAV术后平均回声压差（p=0.03）和BAV术后反流情况（p<0.01）进行预测。BAV术后平均回声压差<30mmHg的患者中，无患者因再狭窄接受再次干预。BAV前后的导管压差对预测免于再次干预接近显著水平（分别为p=0.06和p=0.09）。15例患者为新生儿，其主动脉瓣（AoV）Z值显著更低（平均0.63对1.（此处原文似乎有误，推测应为1.76），p=0.002），但在免于再次干预方面无差异（p=0.19）。瓣环大小、球囊/瓣环比值（在所使用的范围内）以及BAV术前的回声检查结果均不能预测再次干预情况。
球囊主动脉瓣成形术是先天性瓣膜性AS的一种有效主要治疗方法，有可能避免对各年龄段的大多数患者进行手术干预。我们队列中免于再次干预与瓣膜形态以及BAV术后即刻的狭窄和反流程度相关。
