Ring J C, Bass J L, Marvin W, Fuhrman B P, Kulik T J, Foker J E, Lock J E
J Thorac Cardiovasc Surg. 1985 Jul;90(1):35-44.
Twenty-four children, aged 4 months to 16 years (nine patients 2 years old or younger), underwent balloon dilation angioplasty of hypoplastic or stenotic branch pulmonary arteries between July, 1981, and April, 1984. Most children had tetralogy of Fallot, with or without pulmonary atresia, or isolated peripheral pulmonary artery stenosis. Fifty-two dilations were attempted, 44 in the catheterization laboratory and eight in the operating room. Of these, 26 (50%) were judged successful; the average vessel diameter on angiogram increased from 4.1 +/- 0.3 to 7.2 +/- 0.3 mm (76%), the gradient across the narrowed segment fell from 60 +/- 10 to 36 +/- 5 mm (40%), pressure in the main pulmonary artery or right ventricle proximal to the obstruction decreased from 83 +/- 10 to 66 +/- 6 mm Hg (20%), and the radionuclide-determined fraction of cardiac output directed to the lung ipsilateral to the dilated pulmonary artery increased from 40 +/- 4 to 51 +/- 4 (28%). All changes were significant at the p less than 0.005 level. Reasons for failure included inadequate technique (balloon too small, inability to position balloon or wire) in 14 and the refractory nature of the lesion itself in 11. Technical failures were age independent. Nondilatable lesions were more common in children more than 2 years old (10/25 versus 1/10) or with isolated peripheral pulmonary artery stenosis (5/7). Five of seven stenoses near previous shunts were nondilatable. One child exsanguinated when the pulmonary artery ruptured during dilation, but other complications were few. Eight dilations, followed up for an average of 6 months after dilation, showed angiographic persistence of improvement; two of four lesions were successfully redilated to a larger size. Balloon dilation angioplasty appears beneficial, both short and long term, for some patients with hypoplastic or stenotic branch pulmonary arteries, especially if performed early in life.
1981年7月至1984年4月期间，24名年龄在4个月至16岁的儿童（9名2岁及以下患儿）接受了对发育不全或狭窄的肺分支动脉进行球囊扩张血管成形术。大多数儿童患有法洛四联症，伴或不伴有肺动脉闭锁，或孤立性外周肺动脉狭窄。共尝试进行了52次扩张，其中44次在导管室进行，8次在手术室进行。其中，26次（50%）被判定为成功；血管造影显示平均血管直径从4.1±0.3毫米增加到7.2±0.3毫米（增加了76%），狭窄段两端的压差从60±10毫米降至36±5毫米（降低了40%），阻塞近端的主肺动脉或右心室内压力从83±10毫米汞柱降至66±6毫米汞柱（降低了20%），放射性核素测定的流向扩张肺动脉同侧肺的心输出量分数从40±4增加到51±4（增加了28%）。所有变化在p<0.005水平上均具有显著性。失败原因包括技术不充分（球囊过小、无法放置球囊或导丝）14例，以及病变本身难以处理11例。技术失败与年龄无关。难以扩张的病变在2岁以上儿童（10/25对1/10）或孤立性外周肺动脉狭窄患儿（5/7）中更为常见。在先前分流附近的7处狭窄中，有5处难以扩张。1名儿童在扩张过程中肺动脉破裂导致大出血，但其他并发症较少。8次扩张在扩张后平均随访6个月，血管造影显示改善持续存在；4处病变中有2处成功再次扩张至更大尺寸。球囊扩张血管成形术似乎对一些发育不全或狭窄的肺分支动脉患者无论短期还是长期均有益，尤其是在生命早期进行手术时。
