Moore P, Egito E, Mowrey H, Perry S B, Lock J E, Keane J F
Children's Hospital, Boston and Harvard Medical School, Cambridge, Massachusetts, USA.
J Am Coll Cardiol. 1996 Apr;27(5):1257-63. doi: 10.1016/0735-1097(95)00608-7.
We evaluated patient and procedural characteristics that influence the midterm success of balloon dilation of congenital aortic stenosis.
Balloon dilation is a new treatment for congenital aortic stenosis. Factors that influence midterm success are unknown.
We performed a retrospective review of 148 children >1 month old who underwent balloon dilation for aortic stenosis.
Balloon dilation was successful in 87% of patients, with a procedural mortality rate of 0.7%. The average immediate peak to peak gradient reduction was 56.4 +/- 19.9% (mean +/- SD). Prior valvotomy was the only factor that significantly reduced the immediate gradient reduction after dilation (47.1 +/- 21.8% vs. 57.8 +/- 19.6%, p < 0.01). Survival after dilation was 95% at 8 years. Seventy-five percent of patients were free of repeat intervention 4 years after dilation, whereas 50% remained free of repeat intervention at 8 years. Asymmetrically thick valve leaflets (risk ratio [RR] 0.17, p < 0.01) and prior aortic valvotomy (RR 0.35, p = 0.02) decreased the risk of repeat intervention. Aortic regurgitation grade > or = 3 (RR 4.27, p = 0.04) and residual gradient after dilation (RR 1.63 for 10 mm Hg, p < 0.01) increased the risk.
The 8-year survival rate after dilation was 95% with 50% of patients free of repeat intervention. Factors that increased the risk for repeat intervention included symmetrically thin or thick aortic valve leaflets, regurgitation grade > or = 3 after dilation and a high residual gradient after dilation. The incidence of repeat intervention after dilation was high owing to its palliative nature.
我们评估了影响先天性主动脉瓣狭窄球囊扩张术中期成功的患者和手术特征。
球囊扩张术是先天性主动脉瓣狭窄的一种新治疗方法。影响中期成功的因素尚不清楚。
我们对148例年龄大于1个月的接受主动脉瓣狭窄球囊扩张术的儿童进行了回顾性研究。
87%的患者球囊扩张术成功，手术死亡率为0.7%。平均即刻峰-峰压差降低为56.4±19.9%（均值±标准差）。既往瓣膜切开术是唯一显著降低扩张术后即刻压差降低的因素（47.1±21.8%对57.8±19.6%，p<0.01）。扩张术后8年生存率为95%。75%的患者在扩张术后4年无需再次干预，而8年后50%的患者仍无需再次干预。瓣膜叶不对称增厚（风险比[RR]0.17，p<0.01）和既往主动脉瓣切开术（RR 0.35，p=0.02）降低了再次干预的风险。主动脉瓣反流≥3级（RR 4.27，p=0.04）和扩张术后残余压差（10 mmHg时RR 1.63，p<0.01）增加了风险。
扩张术后8年生存率为95%，50%的患者无需再次干预。增加再次干预风险的因素包括主动脉瓣叶对称变薄或增厚、扩张术后反流≥3级和扩张术后高残余压差。由于其姑息性，扩张术后再次干预的发生率较高。
