Rao P S
Department of Paediatrics, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Br Heart J. 1988 Dec;60(6):507-11. doi: 10.1136/hrt.60.6.507.
The relation between the size of the balloon used for dilatation of the pulmonary valve and the extent of relief of pulmonary stenosis both immediately after and at intermediate term follow up was studied. Sixty four balloon dilatation procedures in 56 patients were divided into group 1-12 in which the ratio of the diameter of the balloon to that of the pulmonary annulus was less than or equal to 1.0--and group 2-52 in which the ratio was greater than 1.0. Both groups had similar mean (SD) pressure drops across the pulmonary valve before dilatation. Immediately after dilatation there was a significant reduction in the pulmonary valve gradient in both group 1 (84.3 (39.2) v 43.6 (26.8) mm Hg) and group 2 (92.8 (42.1) v 22.4 (13.6)mm Hg). On intermediate term follow up (6-34 months), residual pulmonary valve gradients were significantly lower in group 2 (20.8 (18.5)mm Hg) than in group 1 (75.0 (49.4) mm Hg), suggesting that restenosis was more common after dilatation with small balloons. These data suggest that although the immediate results with either small or large balloons are good, balloons that are larger than the pulmonary valve annulus produce more sustained relief of pulmonary stenosis. Further analysis within the group treated with larger balloons showed that the subgroup with a balloon/annulus ratio of 1.01-1.2 had more recurrences of stenosis (need for repeat balloon dilatation and larger number of patients with residual pulmonary valve gradients greater than 30 mm Hg) than subgroups with balloon/annulus ratios for diameters of 1.21-1.41, greater than 1.41, and greater than 1.5, in which there were no recurrences. Balloons that were > 1.5 times the size of the pulmonary valve annulus had no additional advantage over the other subgroups, namely, 1.21-- 1.4 and > 1.41. These results and reports of damage to the right ventricular outflow tract by oversized (> 1.5) balloons indicate that balloons that give a balloon/annulus ratio 1.2 -- 1.5 are the best for dilatation of the pulmonary valve.
研究了用于肺动脉瓣扩张的球囊大小与扩张后即刻及中期随访时肺动脉狭窄缓解程度之间的关系。56例患者的64次球囊扩张手术被分为两组：第1组12例，球囊直径与肺动脉瓣环直径之比小于或等于1.0；第2组52例，该比例大于1.0。两组在扩张前经肺动脉瓣的平均（标准差）压力阶差相似。扩张后即刻，第1组（84.3（39.2）对43.6（26.8）mmHg）和第2组（92.8（42.1）对22.4（13.6）mmHg）的肺动脉瓣压力阶差均显著降低。在中期随访（6 - 34个月）时，第2组（20.8（18.5）mmHg）的残余肺动脉瓣压力阶差显著低于第1组（75.0（49.4）mmHg），提示小气球囊扩张后再狭窄更常见。这些数据表明，尽管小气球囊或大气球囊的即刻效果都很好，但大于肺动脉瓣环的球囊能更持久地缓解肺动脉狭窄。对接受大气球囊治疗的组进行进一步分析显示，球囊/瓣环比为1.01 - 1.2的亚组比球囊/瓣环比直径为1.21 - 1.41、大于1.41和大于1.5的亚组有更多的狭窄复发（需要重复球囊扩张，且有更多残余肺动脉瓣压力阶差大于30mmHg的患者），后几个亚组无复发情况。大于肺动脉瓣环1.5倍大小的球囊与其他亚组（即1.21 - 1.4和大于1.41）相比没有额外优势。这些结果以及关于过大（>1.5）球囊对右心室流出道造成损伤的报道表明，球囊/瓣环比为1.2 - 1.5的球囊最适合用于肺动脉瓣扩张。
