经皮球囊肺动脉瓣成形术治疗婴儿和新生儿肺动脉瓣狭窄及闭锁  

Percutaneous balloon pulmonary valvoplasty for pulmonary stenosis and atresia with intact ventricular septum in infants and neonates

作　　者：李虹[1] 李俊杰[1] 石继军[1] 李江林[1] 张旭[1] 徐衍梅[1] 李渝芬[1] 

机构地区：[1]广东省心血管病研究所心儿科,广州510100

出　　处：《中国实用儿科杂志》2010年第1期47-48,51,共3页Chinese Journal of Practical Pediatrics

基　　金：国家"十一五"支撑计划项目(编号2007BA105B00)

摘　　要：目的探讨经皮球囊肺动脉瓣成形(PBPV)术治疗婴儿和新生儿肺动脉瓣狭窄(PS)及室间隔完整型肺动脉瓣闭锁(PA/IVS)的安全性及有效性。方法2006年1月至2009年4月,广东省心血管病研究所心儿科收治PS及PA/IVS婴儿和新生儿63例。其中危重新生儿20例(31.7%)。术前经超声心动图确诊为PS56例,PA/IVS7例。危重新生儿PS需先用直径2.5～4.0mm小球囊预扩张肺动脉瓣,PA/IVS患儿需先行射频瓣膜打孔术。PBPV术所选球囊直径为肺动脉瓣环径(PVAD)1.2～1.3倍(新生儿所选球囊直径为PVAD1.0～1.2倍)。结果全组63例(100%)PBPV术成功。球囊径/瓣环径:1.2±0.1。右室压力明显下降[术前(104.3±32.7)mmHg(1mmHg=0.133kPa),术后(52.0±10.5)mmHg,P<0.001],跨肺动脉瓣压力阶差明显下降[术前(99.2±23.5)mmHg,术后(27.7±12.4)mmHg,P<0.001]。平均手术时间(88.1±36.2)min,平均X线曝光时间(16.9±11.1)min。术中6例(9.5%)出现并发症,2例心包积液,2例低氧血症,1例三尖瓣腱索部分撕裂,1例室上性心动过速。平均随访(19.0±12.3)个月,3例术后因残余中度或重度PS,3个月后再次行PBPV术。本组所有患儿肺动脉瓣仅轻度反流。结论PBPV术治疗婴儿和新生儿PS及PA/IVS安全、有效。Objective To assess the feasibility of Percutaneous balloon pulmonary valvoplasty （PBPV） for pulmonary stenosis and atresia with intact ventricular septum in infants and neonates. Methods From January 2006 to April 2009 in Department of Pediatric, Guangdong Province Cardiovascular Disease Institute, 63 infants and neonales （56 with pulmonary stenosis, 7 with pulmonary atresia） underwent PBPV, 20 of them were neonates （31.7% ）. In neonates with critical pulmonary stenosis, valve should be predilated using a low-profile balloon. In patients with pulmonary atresia, valve should be perforated with a radiofrequency wire, then valvuloplasty performed with a balloon approximately 1.2- 1.3 times the annulus diameter（in neonates, with a balloon approximately 1.0- 1.2 times the annulus diameter ）. Results Sixty three patients （ 100% ） were successfully performed PBPV. The mean ratio of the balloon to annulu was （ 1.2 ±0. 1 ）. Right ventricular systolic pressure was decreased [from （ 104.3± 32.7） mmHg to （52.0 ± 10.5） mmHg, P 〈 0.001], the mean pressure gradient of pulmonary valve was decreased [from （99.2± 23.5） mmHg to （27.7± 12.4） mmHg, P 〈 0.001] The right ventricular angiography showed the pulmonary valves were opened. The mean procedure time was （88.1± 36.2） minutes. The mean fluoroscopy time was （16.9 ±11.1 ） minutes. Six patients （9.5%） appeared complications. There were hemopericardium in 2 patients, hypoxia in 2 patient , tricuspid valve tendon partial rupture in 1 patient and supraventricular tachycardia in 1 patient. The mean follow-up time was （19.0 ± 12.3） months. Three patients with moderate to severe residual puhnonary stenosis underwent a second balloon dilation at the time of follow-up 3 months. All patients had just mild pulmonary regurgitation. Conclusion PBPV for puhnonary stenosis and atresia with intact yentricular septum in infants and neonates is safe and effective.

关 键 词：肺动脉瓣狭窄 室间隔完整型肺动脉瓣闭锁 经皮球囊肺动脉瓣成形术 婴儿 新生儿 

分 类 号：R72[医药卫生—儿科]