Ghannam R, Aouad A, Alami M, Fellat N, Bennani R, Srairi J E, Mesbahi R, el Haitem N, Benomar M
Service de cardiologie et de chirurgie cardiovasculaire, hôpital Avicennes, CHU Ibn Sina, Rabat, Maroc.
Arch Mal Coeur Vaiss. 1998 Oct;91(10):1249-54.
Percutaneous pulmonary valvulotomy is the treatment of choice for isolated congenital pulmonary valvular stenosis in childhood. However, experience of this procedure in the adult is much more limited. Between January 1984 and December 1994, 34 patients with severe or moderate pulmonary valvular stenosis underwent percutaneous transluminal valvuloplasty. The age of the patients ranged from 20 to 47 years (mean 22 +/- 4 years). Cardiac catheterisation was performed using the femoral vein in 27 cases and the internal jugular vein in 7 cases. Success was obtained in 28 patients (81% of cases). Pulmonary artery-right ventricular pressure gradient decreased from 113 +/- 35 to 32 +/- 13 mmHg (p < 0.001) after valvuloplasty with one or two balloon catheters. The tolerance of transluminal valvuloplasty was generally good. The poor results were explained by cases of dysplasic valves or of infundibular reactions. There was one death which occurred 24 hours after the procedure. Clinical and echocardiographic follow-up was obtained in 20 patients, 3 to 36 months after valvuloplasty (average: 23 +/- 13 months). No cases of restenosis were observed. Percutaneous transluminal pulmonary valvuloplasty in the adult is feasible and gives good results which are maintained at medium-term; it has become the treatment of choice of valvular pulmonary stenosis and gives good results which are maintained at medium-term, thereby avoiding surgical valvulotomy.
经皮肺动脉瓣切开术是儿童单纯先天性肺动脉瓣狭窄的首选治疗方法。然而，该手术在成人中的经验要有限得多。1984年1月至1994年12月期间，34例中重度肺动脉瓣狭窄患者接受了经皮腔内瓣膜成形术。患者年龄在20至47岁之间（平均22±4岁）。27例经股静脉行心导管检查，7例经颈内静脉行心导管检查。28例患者手术成功（占病例的81%）。使用一根或两根球囊导管进行瓣膜成形术后，肺动脉-右心室压力阶差从113±35 mmHg降至32±13 mmHg（p<0.001）。经皮腔内瓣膜成形术的耐受性总体良好。结果不佳的原因是瓣膜发育异常或漏斗部反应。有1例患者在术后24小时死亡。20例患者在瓣膜成形术后3至36个月（平均：23±13个月）进行了临床和超声心动图随访。未观察到再狭窄病例。成人经皮腔内肺动脉瓣成形术是可行的，中期效果良好；它已成为肺动脉瓣狭窄的首选治疗方法，中期效果良好，从而避免了外科瓣膜切开术。
