Pedra C A, Gusmão M de O, Esteves C A, Braga S L, Fontes V F
Instituto Dante Pazzanese de Cardiologia, São Paulo.
Arq Bras Cardiol. 1997 May;68(5):327-31.
To evaluate the results of percutaneous balloon valvuloplasty (PBV) for membranous subaortic stenosis (MSAS).
Seven patients with MSAS were submitted to PBV using the retrograde approach. Hemodynamic and angiographic studies were performed before and after the procedure. The balloon/annulus ratio varied between 0.9 to 1.05.
The systolic gradient (SG) between the left ventricle (LV) and aorta was reduced from 57.8 +/- 11.6 to 22.0 +/- 8.6 mmHg (p < 0.001) and the LV systolic pressure from 154.5 +/- 30.3 to 118.7 +/- 18.4 mmHg (p < 0.001). One patient had arterial occlusion and was submitted to surgical embolectomy and another one showed severe mitral regurgitation combined with aortic insufficiency (AI) and required surgical valvuloplasty. There was no mortality. Four patients had a 11 +/- 10 month follow up: the SG measured by echocardiogram was 34 +/- 7 mmHg and no patient showed worsening of the AI.
PBV is an effective procedure to reduce the subaortic SG, with an acceptable morbidity and persistence of the results in the short term follow up. PBV is a valid alternative as an initial mode of therapy in the management of patients with MSAS.
评估经皮球囊瓣膜成形术（PBV）治疗膜性主动脉瓣下狭窄（MSAS）的效果。
7例MSAS患者采用逆行途径接受PBV治疗。在手术前后进行血流动力学和血管造影研究。球囊/瓣环比值在0.9至1.05之间。
左心室（LV）与主动脉之间的收缩期压差（SG）从57.8±11.6 mmHg降至22.0±8.6 mmHg（p<0.001），LV收缩压从154.5±30.3 mmHg降至118.7±18.4 mmHg（p<0.001）。1例患者发生动脉闭塞，接受了外科取栓术，另1例患者出现严重二尖瓣反流合并主动脉瓣关闭不全（AI），需要进行外科瓣膜成形术。无死亡病例。4例患者进行了11±10个月的随访：超声心动图测得的SG为34±7 mmHg，无患者出现AI恶化。
PBV是降低主动脉瓣下SG的有效方法，发病率可接受，且在短期随访中结果持续存在。PBV是MSAS患者初始治疗的有效替代方法。
