Friedli B, Meier B, Oberhänsli I
Clinique de pédiatrie, Hôpital cantonal universitaire, Genève.
Schweiz Med Wochenschr. 1988 Nov 26;118(47):1758-61.
Percutaneous pulmonary valvuloplasty has been used successfully in the treatment of pulmonary valve stenosis for several years, but reports on long-term results are still sparse. We have performed pulmonary valve balloon dilatation procedures 23 times in 22 patients since February 1985; the age of the patients ranged from 2 days to 22 years. Three patients did not benefit from the procedure, in two instances because the pulmonary valve was dysplastic and once because of severe associated infundibular stenosis. These patients subsequently underwent surgery. In the other 19 patients the initial transvalvular gradient of 35 to 160 mm Hg (mean 81 mm Hg) was markedly reduced (to values ranging from 10 to 60 mm Hg, mean 31 mm Hg) rendering surgery unnecessary. There were no complications. The patients have been followed up for periods ranging from 2 months to 3 years and all are asymptomatic. Repeat measurements of the transvalvular gradient were carried out either by recatheterization or by echo Doppler 4 months to 3 years after the procedure; we have not observed restenosis and the mean gradient remained unchanged compared to the measurements immediately after valvuloplasty. Pulmonary regurgitation was uncommon and indeed appears to be less prominent than after surgical valvotomy. Thus, percutaneous valvuloplasty now appears to be the preferred treatment for pulmonary valve stenosis and open heart surgery can be avoided in most cases.
经皮肺动脉瓣成形术已成功用于治疗肺动脉瓣狭窄数年，但关于长期结果的报道仍然很少。自1985年2月以来，我们对22例患者进行了23次肺动脉瓣球囊扩张术；患者年龄从2天至22岁不等。3例患者未从该手术中获益，2例是因为肺动脉瓣发育异常，1例是因为伴有严重的漏斗部狭窄。这些患者随后接受了手术。在其他19例患者中，最初的跨瓣压差为35至160毫米汞柱（平均81毫米汞柱），显著降低（降至10至60毫米汞柱，平均31毫米汞柱），从而无需进行手术。无并发症发生。对患者进行了2个月至3年的随访，所有患者均无症状。在术后4个月至3年通过再次心导管检查或超声多普勒对跨瓣压差进行了重复测量；我们未观察到再狭窄，与瓣膜成形术后立即测量相比，平均压差保持不变。肺动脉瓣反流并不常见，实际上似乎比手术瓣膜切开术后要轻。因此，经皮瓣膜成形术现在似乎是肺动脉瓣狭窄的首选治疗方法，大多数情况下可避免进行心脏直视手术。
