Chen C R, Cheng T O, Huang T, Zhou Y L, Chen J Y, Huang Y G, Li H J
Department of Cardiology, Guangdong Cardiovascular Institute, China.
N Engl J Med. 1996 Jul 4;335(1):21-5. doi: 10.1056/NEJM199607043350104.
Percutaneous balloon valvuloplasty has been the accepted first-line treatment for congenital pulmonic stenosis in children. Its efficacy in adolescents and adults is less well defined.
Between December 1985 and July 1995 we performed percutaneous pulmonic valvuloplasty with a single Inoue balloon catheter in 53 adolescent or adult patients 13 to 55 years of age (mean [+/- SD], 26 +/- 11). Follow-up studies were performed 0.2 to 9.8 years after the procedure (mean, 6.9 +/- 3.1) by Doppler echocardiography (in all the patients) and by cardiac catheterization and angiography (in nine patients).
After balloon valvuloplasty, the systolic pressure gradient across the pulmonic valve decreased from 91 +/- 46 mm Hg to 38 +/- 32 mm Hg (P < 0.001), and the diameter of the pulmonic-valve orifice increased from 8.9 +/- 3.6 mm to 17.4 +/- 4.6 mm (P < 0.001). In the nine patients catheterized at follow-up, the systolic gradient decreased from 107 +/- 48 mm Hg before valvuloplasty to 50 +/- 29 mm Hg after valvuloplasty and to 30 +/- 16 mm Hg at follow-up (P < 0.001 for the comparison of the gradient before and after valvuloplasty; P < 0.001 for the comparison before valvuloplasty and at follow-up; and P < 0.05 for the comparison after valvuloplasty and at follow-up). In the same nine patients, the diameter of the pulmonic valve, as measured by right ventricular angiography, increased from 8.3 +/- 1.4 mm before valvuloplasty to 17.2 +/- 2.0 mm after valvuloplasty (P < 0.001) and to 18.4 +/- 1.4 mm at follow-up (P = 0.08). Incompetence of the pulmonic valve was noted in 7 of the 53 patients (13 percent) after balloon valvuloplasty, but it had disappeared at follow-up in all of them.
Patients with congenital pulmonic stenosis who present in late adolescence or adult life can be treated with percutaneous balloon valvuloplasty with excellent short-term and long-term results that are similar to those in young children.
经皮球囊瓣膜成形术一直是儿童先天性肺动脉狭窄公认的一线治疗方法。其在青少年和成人中的疗效尚不太明确。
1985年12月至1995年7月期间，我们使用单根井上球囊导管对53例年龄在13至55岁（平均[±标准差]，26±11岁）的青少年或成人患者进行了经皮球囊肺动脉瓣膜成形术。术后0.2至9.8年（平均，6.9±3.1年）通过多普勒超声心动图（所有患者）以及心导管检查和血管造影（9例患者）进行随访研究。
球囊瓣膜成形术后，肺动脉瓣跨瓣收缩压梯度从91±46mmHg降至38±32mmHg（P<0.001），肺动脉瓣口直径从8.9±3.6mm增加至17.4±4.6mm（P<0.001）。在随访时接受心导管检查的9例患者中，收缩压梯度从瓣膜成形术前的107±48mmHg降至瓣膜成形术后的50±29mmHg，并在随访时降至30±16mmHg（瓣膜成形术前与术后比较，P<0.001；瓣膜成形术前与随访时比较，P<0.001；瓣膜成形术后与随访时比较，P<0.05）。在同一9例患者中，通过右心室血管造影测量的肺动脉瓣直径从瓣膜成形术前的8.3±1.4mm增加至瓣膜成形术后的17.2±2.0mm（P<0.001），并在随访时增至18.4±1.4mm（P = 0.08）。53例患者中有7例（13%）在球囊瓣膜成形术后出现肺动脉瓣关闭不全，但在随访时均已消失。
在青春期末期或成年期出现的先天性肺动脉狭窄患者可以接受经皮球囊瓣膜成形术治疗，其短期和长期效果极佳，与幼儿相似。
