经皮球囊肺动脉瓣成形术治疗重度先天性肺动脉瓣狭窄患者的疗效及操作方法改进  

Effects and operation method improvement of percutaneous balloon pulmonary valvuloplasty for the treatment of patients with serious congenital pulmonary valve stenosis

作　　者：何国祥[1] 宋治远[1] 迟路湘[2] 司良毅[3] 胡厚源[1] 舒茂琴[1] 唐波[1] 刘建平[1] 冉擘力[1] 

机构地区：[1]第三军医大学西南医院心血管内科,重庆400038 [2]第三军医大学西南医院神经内科,重庆400038 [3]第三军医大学西南医院老年科,重庆400038

出　　处：《重庆医学》2006年第3期203-204,共2页Chongqing medicine

摘　　要：目的探讨重度先天性肺动脉瓣狭窄(PS)患者施行经皮球囊肺动脉瓣成形术(PBPV)的方法改进和注意事项,并总结其疗效。方法重度PS患者,因右心导管不能通过瓣口或当通过时出现缺氧性昏厥、抽搐及呼吸骤停,故采用Inoue球囊导管、参考经皮球囊二尖瓣成形术(PBMV)时球囊导管通过房间隔的方法,并加以改良通过肺动脉瓣口行PBPV。结果17例均获得有效扩张,PBPV后右心室压(RVP)由(133±29)mm Hg(1mm Hg=0.133kPa)下降至(45±13)mm Hg,差异有统计学意义(P<0.01),肺动脉瓣跨瓣压差(PVG)从(89±28)mm Hg下降至(21±11)mm Hg,差异有统计学意义(P<0.01),肺动脉瓣口面积(PVA)则由(0.62±0.31)cm2增大至(1.98±0.38)cm2,差异有统计学意义(P<0.01),肺动脉压没有显著改变,差异无统计学意义(P>0.05)。临床症状、体征改善,平均随访(106±26)个月无再狭窄发生。结论对特别严重的PS患者,采用Inoue球囊导管、参考PBMV时球囊导管通过房间隔的方法,并加以改良通过肺动脉瓣口能够获得满意的有效扩张,操作便捷、安全。Objective To evaluate the therapeutic effect and the modified procedure of percutaneous balloon pulmonary valvuloplasty （PBPV） for the treatment of congenital pulmonary valve stenosls. Methods In order to avoid the difficulties to enter the pulmonary artery or to resuh in the hypoxia syncope, spasm and sudden respiratory arrest, the modified method of Inoue mitral balloon catheter was used to dilate the serious pulmonary valve stenosis according to the method of percutaneous balloon mitral val vuloplasty （PBMV）. Results Seventeen patients with congenital pulmonary valve stenosis were studied. After dilated by PBPV with the modified lnoue mitral balloon catheter, the right ventricular pressure（RVP）significantly decreased from （133 ± 29）mm Hg （lmm Hg=0.133kPa） to （45±13）mm Hg and pulmonary valve gradient（PVG）decreased from （89±28）mm Hg to （21±11）mm Hg respectively（P〈0.01 ）, the pulmonary valve area （PVA） increased obviously from （0.62 ±0.31） cm^2 to （ 1 . 98 ± 0.38） cm^2 （P 〈0.01）, the pulmonary artery pressure（PAP） had not a significant change （P〉0.05）. The clinic symptoms and physical signs were improved at the same time. There were no pulmonary valve rest enosis during follow up of （106± 26）months. Conclusion In patients with serious pulmonary valve stenosis, the Inoue balloon techniques can be modified and used in PBPV. The results suggest that the method is effective for the treatment of serious pulmonary valve stenosis. It also is a safe and simple method.

关 键 词：重度肺动脉瓣猿窄 先天性 治疗 经皮球囊肺动脉瓣成形术 

分 类 号：R541.1[医药卫生—心血管疾病]