Godart F, Rey C, Muilwijk C, Francart C, Brevière G M, Vaksmann G
Service de cardiologie infantile, CHU de Lille.
Arch Mal Coeur Vaiss. 1996 May;89(5):533-9.
Percutaneous pulmonary valvuloplasty remains controversial as a palliative procedure in Tetralogy of Fallot. This paper reports the results of this technique with respect to clinical improvement and growth of the pulmonary arterial tree. Between June 1990 and July 1995, valvuloplasty with a balloon catheter was performed in 25 neonates or infants with Tetralogy of Fallot (13 girls and 12 boys). All patients were symptomatic with severe cyanosis associated with anoxic malaise in 14 cases. At catheterisation, the children were aged 3.5 +/- 2.6 months and weighted 4.7 +/- 1.2 kg. After dilatation, cutaneous oxygen saturation increased from 75 +/- 11 to 88 +/- 8% (p = 0.001). However, 3 children were referred for early surgery (one complete correction and two systemico-pulmonary anastomoses because of persistent desaturation. There were no lethal complications. A control (catheterisation or surgery) allowed evaluation of the growth of the pulmonary tract, on average 5.5 +/- 4.3 months after dilatation. The pulmonary artery diameter increased from 6.17 +/- 1.26 mm to 8.66 +/- 1.22 mm (p = 0.0015). Expressed as a Z score, the annulus diameter changed from -3.93 +/- 0.91 to -2.54 +/- 1.2 SD (p = 0.0019). The mean Z score of the right pulmonary artery increased from -3.01 +/- 0.69 to -1.98 +/- 1.12 SD (p = 0.0251) and the Z score of the left pulmonary artery from -2.68 +/- 0.85 to -1.61 +/- 1.46 SD (p = 0.0357). At complete correction, 50% of patients had had correction of their malformation without section of the pulmonary annulus. In conclusion, pulmonary valvuloplasty in Tetralogy of Fallot enables growth of the annulus and pulmonary arteries and is a valuable alternative to palliative systemico-pulmonary anastomosis.
经皮肺动脉瓣成形术作为法洛四联症的一种姑息性手术仍存在争议。本文报告了该技术在临床改善及肺动脉树生长方面的结果。1990年6月至1995年7月期间，对25例法洛四联症新生儿或婴儿（13例女孩和12例男孩）实施了球囊导管瓣膜成形术。所有患者均有症状，其中14例伴有严重紫绀及缺氧不适。导管插入时，患儿年龄为3.5±2.6个月，体重4.7±1.2千克。扩张后，皮肤氧饱和度从75±11%升至88±8%（p = 0.001）。然而，3例患儿被转诊接受早期手术（1例接受完全矫正，2例因持续低氧饱和度接受体肺分流术）。无致命并发症发生。通过对照（导管插入或手术）评估了扩张后平均5.5±4.3个月时肺动脉的生长情况。肺动脉直径从6.17±1.26毫米增至8.66±1.22毫米（p = 0.0015）。以Z值表示，瓣环直径从-3.93±0.91变为-2.54±1.2标准差（p = 0.0019）。右肺动脉平均Z值从-3.01±0.69升至-1.98±1.12标准差（p = 0.0251），左肺动脉Z值从-2.68±0.85升至-1.61±1.46标准差（p = 0.0357）。在完全矫正时，50%的患者在未切开肺动脉瓣环的情况下矫正了畸形。总之，法洛四联症的肺动脉瓣成形术可使瓣环和肺动脉生长，是姑息性体肺分流术的一种有价值的替代方法。
