Letac B, Cribier A, Koning R, Bellefleur J P
Service de Cardiologie, Centre Hospitalo-Universitaire, Hôpital Charles-Nicolle, Rouen, France.
Am J Cardiol. 1988 Sep 15;62(9):598-605. doi: 10.1016/0002-9149(88)90663-7.
The results of balloon aortic valvuloplasty (BAV) in 218 adult patients with valvular aortic stenosis (AS) are reported. In most cases, 3 transcutaneously introduced balloons of successively increasing size were used. Tolerance was excellent in 64%, whereas a decrease in blood pressure below 60 mm Hg during inflation was observed in 36%. The left ventricular-aortic peak to peak gradient decreased from 72 +/- 25 to 29 +/- 14 mm Hg (p less than 0.001) and the aortic valve area increased from 0.52 +/- 0.18 to 0.93 +/- 0.33 cm2 (p less than 0.001). The final aortic valve area was greater than or equal to 1 cm2 in 69 patients (32%). In only 6 cases (3%) the aortic valve area did not change or increased by less than 10%. A clear improvement in the results was observed with gained experience and better catheters. There was 1 death and 1 stroke in the procedure room, and 3 strokes after BAV. Nine patients died shortly after the procedure. There were local complications (hematoma or thrombosis) at the femoral puncture site in 28 (13%) patients. Clinical follow-up was obtained for 144 patients (mean 8 months). There were 24 deaths. In the 120 remaining cases, symptomatic improvement was good in 84%, with decrease or disappearance of dyspnea, angina or both. This study demonstrates that BAV is feasible in adult AS at a low risk and is able to produce marked clinical improvement in most cases.
报告了218例成人主动脉瓣狭窄（AS）患者接受球囊主动脉瓣成形术（BAV）的结果。在大多数情况下，使用了3个经皮插入、尺寸依次增大的球囊。64%的患者耐受性良好，而36%的患者在球囊扩张时血压降至60 mmHg以下。左心室-主动脉峰峰值压差从72±25 mmHg降至29±14 mmHg（p<0.001），主动脉瓣面积从0.52±0.18 cm²增加至0.93±0.33 cm²（p<0.001）。69例患者（32%）的最终主动脉瓣面积大于或等于1 cm²。仅6例（3%）患者的主动脉瓣面积未改变或增加不到10%。随着经验的积累和导管的改进，结果有明显改善。手术室内有1例死亡和1例中风，BAV术后有3例中风。9例患者在术后不久死亡。28例（13%）患者在股动脉穿刺部位出现局部并发症（血肿或血栓形成）。对144例患者进行了临床随访（平均8个月）。有24例死亡。在其余120例患者中，84%有症状改善，呼吸困难、心绞痛或两者均减轻或消失。本研究表明，BAV在成人AS患者中低风险可行，且在大多数情况下能产生明显的临床改善。
