患有严重肺动脉狭窄或室间隔完整的膜性肺动脉闭锁的婴儿行球囊瓣膜切开术成功的决定因素。

Determinants of successful balloon valvotomy in infants with critical pulmonary stenosis or membranous pulmonary atresia with intact ventricular septum.

作者信息

Fedderly R T, Lloyd T R, Mendelsohn A M, Beekman R H

机构信息

Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor.

出版信息

J Am Coll Cardiol. 1995 Feb;25(2):460-5. doi: 10.1016/0735-1097(94)00405-f.

DOI:10.1016/0735-1097(94)00405-f

PMID:7829801

Abstract

OBJECTIVES

This study reviewed our experience with percutaneous balloon valvotomy in infants with critical pulmonary stenosis or membranous pulmonary atresia with intact ventricular septum and defined the anatomic and hemodynamic characteristics of infants in whom this procedure is successful and provides definitive therapy.

BACKGROUND

Unlike children with valvular pulmonary stenosis, the follow-up of infants with critical pulmonary stenosis undergoing percutaneous balloon valvotomy is limited.

METHODS

Between December 1987 and August 1992, percutaneous balloon valvotomy was attempted in 12 infants with critical pulmonary stenosis (n = 10) or pulmonary atresia with intact ventricular septum (n = 2). Two outcome groups were identified: Group A patients are acyanotic, have mild residual pulmonary stenosis and have not required operation; Group B patients have required operation.

RESULTS

Of the 12 infants, 11 had a successful balloon valvotomy procedure. Group A patients (n = 7) have a residual gradient of 22 +/- 18.7 mm Hg (mean +/- SD) at follow-up of 3.2 years (range 1.2 to 5.0). In Group B (n = 5), operation was required for inability to cross the pulmonary valve (n = 1) or persistent severe hypoxemia for > or = 2 weeks after valvotomy (n = 4). Significant differences (p < or = 0.01) between the two groups (Group A vs. Group B) were identified in pulmonary valve annulus (Z value) 8.1 mm (-1.1) versus 5.5 mm (-3.4); tricuspid valve annulus (Z value) 14.0 mm (0.8) versus 8.8 mm (-1.8); right ventricular volume 65 versus 29 ml/m2; and Lewis index 10.9 versus 8.9.

CONCLUSIONS

Percutaneous balloon valvotomy is effective and likely to provide definitive therapy in infants with critical pulmonary stenosis or membranous pulmonary atresia with intact ventricular septum who have a tricuspid valve annulus > 11 mm, pulmonary valve annulus > or = 7 mm and right ventricular volume > 30 ml/m2.

摘要

目的

本研究回顾了我们对患有严重肺动脉狭窄或室间隔完整的膜性肺动脉闭锁婴儿进行经皮球囊瓣膜切开术的经验，并确定了该手术成功并提供确定性治疗的婴儿的解剖学和血流动力学特征。

背景

与患有瓣膜性肺动脉狭窄的儿童不同，对接受经皮球囊瓣膜切开术的严重肺动脉狭窄婴儿的随访有限。

方法

在1987年12月至1992年8月期间，对12例患有严重肺动脉狭窄（n = 10）或室间隔完整的肺动脉闭锁（n = 2）的婴儿尝试进行经皮球囊瓣膜切开术。确定了两个结果组：A组患者无紫绀，有轻度残余肺动脉狭窄且无需手术；B组患者需要手术。

结果

12例婴儿中，11例经皮球囊瓣膜切开术成功。A组患者（n = 7）在3.2年（范围1.2至5.0）的随访中残余压差为22±18.7 mmHg（平均值±标准差）。在B组（n = 5）中，因无法穿过肺动脉瓣（n = 1）或瓣膜切开术后持续严重低氧血症≥2周（n = 4）而需要手术。两组（A组与B组）之间在肺动脉瓣环（Z值）8.1 mm（-1.1）与5.5 mm（-3.4）；三尖瓣环（Z值）14.0 mm（0.8）与8.8 mm（-1.8）；右心室容积65与29 ml/m²；以及刘易斯指数10.9与8.9方面存在显著差异（p≤0.01）。