Burzynski J B, Kveselis D A, Byrum C J, Kavey R E, Smith F C, Gaum W E
State University of New York Health Science Center, Syracuse.
J Am Coll Cardiol. 1993 Dec;22(7):1944-7. doi: 10.1016/0735-1097(93)90783-w.
We report our experience in eight consecutive neonates who underwent attempted balloon dilation as an initial therapy for critical valvular pulmonary stenosis, and we review in detail technical modifications that improved the success rate.
Balloon dilation of the pulmonary valve has become the treatment of choice for valvular pulmonary stenosis in children and adults. There are few reports of its effectiveness in critical pulmonary stenosis in the newborn. In this setting, application of the technique of balloon dilation has been limited by the ability to advance the necessary guide wires and catheters across the stenotic, often near-atretic, pulmonary valve.
The pulmonary valve was crossed in all patients. When this could not be accomplished with an end-hole catheter, a soft guide wire was advanced directly across the pulmonary valve through the end-hole catheter positioned in the right ventricular outflow tract below the valve. Initial predilation was achieved in all patients by using a coronary dilation catheter in an effort to facilitate introduction of the definitive balloon dilation catheter. Definitive dilation with a balloon diameter of > or = 110% of the diameter of the pulmonary valve annulus was possible in six patients.
Right ventricular pressure declined from a mean value of 108 +/- 32 mm Hg to a mean value of 49 +/- 11 mm Hg after balloon dilation, with no change in heart rate or aortic pressure in these six patients after definitive balloon dilation.
The results of this small series suggest that critical valvular pulmonary stenosis in the newborn can be successfully treated by transluminal balloon valvuloplasty.
我们报告了连续8例接受球囊扩张术作为重症瓣膜性肺动脉狭窄初始治疗的新生儿的经验，并详细回顾了提高成功率的技术改进措施。
肺动脉瓣球囊扩张术已成为儿童和成人瓣膜性肺动脉狭窄的首选治疗方法。关于其在新生儿重症肺动脉狭窄中的有效性报道较少。在这种情况下，球囊扩张技术的应用受到将必要的导丝和导管穿过狭窄的、通常近乎闭锁的肺动脉瓣的能力的限制。
所有患者的肺动脉瓣均被穿过。当使用端孔导管无法完成时，将一根软导丝通过置于瓣膜下方右心室流出道的端孔导管直接推进穿过肺动脉瓣。所有患者均通过使用冠状动脉扩张导管进行初始预扩张，以利于引入最终的球囊扩张导管。6例患者能够使用直径≥肺动脉瓣环直径110%的球囊进行最终扩张。
球囊扩张后，这6例患者的右心室压力从平均值108±32 mmHg降至平均值49±11 mmHg，最终球囊扩张后心率和主动脉压力无变化。
这个小系列的结果表明，新生儿重症瓣膜性肺动脉狭窄可通过经腔球囊瓣膜成形术成功治疗。
