Cribier A, Savin T, Saoudi N, Behar P, Rocha P, Mechmèche R, Berland J, Letac B
Arch Mal Coeur Vaiss. 1986 Nov;79(12):1678-86.
Aortic valvular dilatation with a balloon catheter was performed in 44 patients, 20 men and 24 women, most of whom were very elderly (average age 77 years). The indication for valvular replacement had not been retained in these cases because of surgical contra-indications or a very high operative risk and in 3 cases because of patient refusal. Twenty-nine patients were in functional classes III or IV of the NYHA classification; 12 had syncopal episodes and 18 had invalidating angina. The dilatation was performed by a femoral arterial approach in 34 cases, and by a brachial arterial approach in 10 cases. MEDI-TECH catheters with 15, 18 or 20 mm diameters when inflated were used in the majority of cases. Several inflations lasting 10 to 240 seconds were performed in each case with balloons of increasing size. This was well tolerated in all but one patients who had a sharp syncope. The immediate results confirmed valvular dilatation. The average transvalvular pressure gradient fell from 76 +/- 25 mmHg to 30 +/- 13 mmHg (p less than 0.001). The aortic valve surface area calculated by the Gorlin formula increased from 0.5 +/- 0.18 cm2 to 1 +/- 0.42 cm2 (p less than 0.01). After dilatation the gradient was less than or equal to 40 mmHg in 37 cases; aortic valve surface area was greater than or equal to 1 cm2 in 14 cases and less than or equal to 0.7 cm2 in only 5 cases. The left ventricular ejection fraction increased immediately after valvuloplasty from 44 +/- 16 p. 100 to 49 +/- 15 p. 100 (p less than 0.01). In the 18 cases in which it was less than 40 p. 100 before valvuloplasty, it increased from 30 +/- 6 p. 100 to 36 +/- 9 p. 100 (p less than 0.02). Residual aortic regurgitation was only observed in one case. Two patients died in the hospital period (4.6 p. 100). There were no other serious complications. During an average follow-up period of 60 days (3 weeks to 6 months) there was a big improvement in symptoms in the great majority of cases and, in particular, syncopal and anginal attacks disappeared. Only 4 patients remained in functional classes III or IV after valvuloplasty. Percutaneous aortic valvuloplasty is a new, relatively simple, low risk, economic and very effective therapeutic procedure in all cases in which aortic valve replacement is contra-indicated or refused by the patient.(ABSTRACT TRUNCATED AT 400 WORDS)
对44例患者（20例男性，24例女性）进行了球囊导管主动脉瓣扩张术，其中大多数患者年龄很大（平均年龄77岁）。由于手术禁忌证或手术风险极高，以及3例患者拒绝手术，这些病例未保留瓣膜置换的指征。29例患者属于纽约心脏协会（NYHA）分级的III或IV级功能状态；12例有晕厥发作，18例有严重心绞痛。34例通过股动脉途径进行扩张，10例通过肱动脉途径进行扩张。大多数病例使用充气后直径为15、18或20毫米的MEDI-TECH导管。每个病例使用尺寸逐渐增大的球囊进行数次持续10至240秒的充气。除1例发生严重晕厥的患者外，所有患者对该操作耐受性良好。即刻结果证实了瓣膜扩张。平均跨瓣压差从76±25 mmHg降至30±13 mmHg（p<0.001）。根据Gorlin公式计算的主动脉瓣面积从0.5±0.18 cm²增加到1±0.42 cm²（p<0.01）。扩张后，37例患者的压差小于或等于40 mmHg；14例患者的主动脉瓣面积大于或等于1 cm²，仅5例患者的主动脉瓣面积小于或等于0.7 cm²。瓣膜成形术后左心室射血分数立即从44±16%升至49±15%（p<0.01）。在瓣膜成形术前射血分数低于40%的18例患者中，其射血分数从30±6%升至36±9%（p<0.02）。仅1例观察到残余主动脉瓣反流。2例患者在住院期间死亡（4.6%）。无其他严重并发症。在平均60天（3周至6个月）的随访期内，绝大多数病例的症状有显著改善，尤其是晕厥和心绞痛发作消失。瓣膜成形术后仅4例患者仍处于NYHA分级的III或IV级功能状态。经皮主动脉瓣成形术是一种新的、相对简单、低风险、经济且非常有效的治疗方法，适用于所有主动脉瓣置换术禁忌或患者拒绝的病例。（摘要截短至400字）
