Kin H, Ishibashi Y, Tanabe K, Nakamura K, Matsumoto H, Okada S, Sano K, Shimada T, Morioka S
Fourth Department of Internal Medicine, Shimane Medical University, Izumo, Japan.
Jpn Circ J. 1997 Feb;61(2):192-6. doi: 10.1253/jcj.61.192.
Percutaneous balloon valvuloplasty has been established as an effective treatment for pulmonary valve stenosis (PS) in children and adults. However, there are few reports of the use of this technique in patients with other cardiac anomalies. We report the performance of balloon pulmonary valvuloplasty in a 72-year-old woman with a large atrial septal defect (ASD). This patient had a PS with a right ventricular pressure of 108/18 mmHg and a pulmonary arterial pressure of 42/21 mmHg, corresponding to a 66 mmHg pressure gradient. The ASD measured 32 x 27 mm. Balloon pulmonary valvuloplasty reduced the pressure gradient to 5 mmHg immediately after the procedure and to 2 mmHg 40 days after the procedure. The left-to-right shunt ratio was reduced from 17% before to 12% immediately after and to 36% 40 days after the procedure. In contrast, the right-to-left shunt ratio showed a transient increase from 16% before to 28% immediately after the procedure before decreasing to 11% 40 days after the procedure. The arterial blood oxygen tension was 53 Torr before, 46 Torr immediately after and 55 Torr 40 days after the procedure. The grade of heart failure decreased from New York Heart Association class IV before to class II in the chronic stage. These findings indicated that balloon pulmonary valvuloplasty in a patient with ASD transiently increased the right-to-left shunting associated with a decrease in oxygen tension, but that the change in the chronic stage was slight. In our patient with ASD valvuloplasty was useful in relieving the symptoms associated with elevated right ventricular pressure but could not reduce the hypoxemia caused by right-to-left shunting. In conclusion, valvuloplasty in patients with ASD should be considered as a preoperative treatment with the aim of reducing the risk of surgery and to treat symptoms in patients who refuse to undergo surgery.
经皮球囊瓣膜成形术已被确立为治疗儿童和成人肺动脉瓣狭窄（PS）的有效方法。然而，关于该技术在其他心脏异常患者中的应用报道较少。我们报告了一名72岁患有大型房间隔缺损（ASD）女性患者的球囊肺动脉瓣成形术情况。该患者患有PS，右心室压力为108/18 mmHg，肺动脉压力为42/21 mmHg，压力阶差为66 mmHg。ASD大小为32×27 mm。球囊肺动脉瓣成形术后，压力阶差立即降至5 mmHg，术后40天降至2 mmHg。左向右分流率从术前的17%降至术后即刻的12%，术后40天降至36%。相比之下，右向左分流率则出现短暂升高，从术前的16%升至术后即刻的28%，然后在术后40天降至11%。动脉血氧张力术前为53 Torr，术后即刻为46 Torr，术后40天为55 Torr。心力衰竭分级从术前的纽约心脏协会IV级降至慢性期的II级。这些发现表明，ASD患者进行球囊肺动脉瓣成形术会短暂增加右向左分流并伴有氧张力降低，但慢性期变化轻微。在我们的ASD患者中，瓣膜成形术有助于缓解与右心室压力升高相关的症状，但无法减轻右向左分流导致的低氧血症。总之，ASD患者的瓣膜成形术应被视为一种术前治疗方法，旨在降低手术风险并治疗拒绝接受手术患者的症状。
