Sholler G F, Keane J F, Perry S B, Sanders S P, Lock J E
Department of Cardiology, Children's Hospital, Boston, MA 02115.
Circulation. 1988 Aug;78(2):351-60. doi: 10.1161/01.cir.78.2.351.
We evaluated dilation technique (n = 80) and aortic valve morphology by two-dimensional echocardiography (n = 58) in patients with congenital aortic valve stenosis to determine their influence on outcome. Patients' age (9 +/- 9 years; range, 1 day-39 years) and a history of surgical valvotomy did not influence outcome. The number of dilating balloons (one vs. two) and balloon: annulus ratio based on the largest balloon used in each case (97 +/- 12%; range, 71-133%) did not demonstrably influence the percent reduction in valvar gradient. In contrast, with a balloon: annulus ratio greater than 100%, the incidence (26%) of significant, dilation-induced aortic regurgitation was higher than occurred when the ratio was equal to or less than 100% (11%). Fifty bicommissural and eight unicommissural valves were identified echocardiographically. Relief of obstruction was associated with apparent commissural division in 24 of 32 patients with suitable postdilation studies. The sites of fusion and stenosis relief did not influence percent reduction in valvar gradient. Substantial increases in aortic regurgitation (greater than three of five grades) occurred in three of eight unicommissural and one of 50 bicommissural valves. The presence of a thick valve was associated with a slightly lower gradient reduction (53 +/- 12%) than thin and pliant valves (63 +/- 24%) (p greater than 0.05). Unlike all other congenital lesions we have studied, dilation technique and balloon size appeared to have a lesser influence on percent reduction in valvar gradient in congenital aortic stenosis, although balloon: annulus ratio influences the increase in aortic regurgitation. Valve morphology appears to assist with predicting the outcome of dilation.
我们通过二维超声心动图对80例先天性主动脉瓣狭窄患者评估了扩张技术，并对58例患者评估了主动脉瓣形态，以确定它们对治疗结果的影响。患者的年龄（9±9岁；范围1天至39岁）和外科瓣膜切开术病史不影响治疗结果。扩张球囊的数量（一个与两个）以及基于每种情况下使用的最大球囊的球囊：瓣环比率（97±12%；范围71 - 133%）并未明显影响瓣膜压差的降低百分比。相比之下，当球囊：瓣环比率大于100%时，显著的、扩张诱发的主动脉瓣反流发生率（26%）高于该比率等于或小于100%时的发生率（11%）。通过超声心动图识别出50个双叶瓣和8个单叶瓣。在32例有合适扩张后研究的患者中，24例梗阻缓解与明显的瓣叶融合分离有关。融合部位和狭窄缓解情况不影响瓣膜压差的降低百分比。8个单叶瓣中有3个以及50个双叶瓣中有1个出现主动脉瓣反流显著增加（大于五级中的三级）。与薄且柔顺的瓣膜（63±24%）相比，厚瓣膜的压差降低略低（53±12%）（p＞0.05）。与我们研究过的所有其他先天性病变不同，在先天性主动脉瓣狭窄中，扩张技术和球囊大小对瓣膜压差降低百分比的影响似乎较小，尽管球囊：瓣环比率会影响主动脉瓣反流的增加。瓣膜形态似乎有助于预测扩张的结果。
