激光打孔球囊瓣膜成形术治疗肺动脉瓣闭锁伴室间隔完整患儿的研究  

Excimer laser guidewire penetration of the imperforate valve and balloon valvuloplasty for pulmonary atresia with intact ventricular septum

作　　者：梁平[1] 周启东[1] 张耀辉[1] 翁德璋[1] 

机构地区：[1]香港大学葛量洪医院小儿心脏科

出　　处：《中华儿科杂志》1998年第9期524-525,共2页Chinese Journal of Pediatrics

摘　　要：目的探讨激光打孔球囊瓣膜成形术治疗婴儿及新生儿肺动脉瓣闭锁伴室间隔完整的方法的可行性。方法１９９６年１月～１９９７年１０月，对７例肺动脉瓣闭锁伴室间隔完整的患儿行心导管术，并以直径为００１８英寸（０４６ｍｍ）激光导丝对闭锁的肺动脉瓣行激光打孔。导丝在已到达漏斗部的心导管的引导下至闭锁的肺动脉瓣。激光打孔后再以球囊扩张瓣膜。结果７例患儿，其中６例激光打孔球囊瓣膜成形术获得成功。在随访中，２例需行改良的ＢｌａｌｏｃｋＴａｕｓｉｎｇ分流术，以维持动脉血氧饱和度达８０％以上。球囊瓣膜成形术后，５例右心室发育获得改善，其三尖瓣环内径及漏斗部内径均较术前明显增加（Ｐ分别＜００５及０００５）。结论对患有肺动脉瓣闭锁伴室间隔完整的婴儿。Objective To evaluate the initial experience of using Excimer laser guidewire penetration of the imperforate valve and balloon valvuloplasty for infants with pulmonary atresia and intact ventricular septum.Methods Seven consecutive babies with pulmonary atresia and intact ventricular septum referred between January 1996 to October 1997 were catheterized. The imperforate pulmonary valve was penetrated using a 0.018inch (0.46 mm) guidewire attached to an Excimer laser. The guidewire was introduced through a catheter previously lodged in the infundibular cavity and abutting on the atretic pulmonary valve. After penetration, the valve was dilated with progressively larger balloons.Results Excimer laser energy was applied in 7 babies and 6 (86%) had successful penetration of the imperforate pulmonary valve. The 6 babies with successful penetration of the imperforate valve all had successful valvuloplasty. On followup, 2 babies required a modified BlalockTaussig shunt to maintain the arterial saturation above 80%. The growth of the right ventricular cavity after balloon valvuloplasty was documented in 5 patients with significantly larger diameters of the tricuspid valvar annulus (P<0.005) and infundibular cavity (P<0.0005).Conclusion Excimer laser guidewire penetration of the imperforate pulmonary valve followed by balloon valvuloplasty is an acceptable nonsurgical alternative treatment for babies suffering from pulmonary atresia and intact ventricular septum.

关 键 词：肺动脉瓣闭锁 瓣膜成形 气囊扩张术 儿童 打孔 

分 类 号：R725.432[医药卫生—儿科] R726.542[医药卫生—临床医学]