6月龄以下小婴儿危重型肺动脉瓣狭窄经皮球囊肺动脉瓣扩张成形术治疗的随访报告  

Percutaneous balloon pulmonary valvuloplasty for critical pulmonary stenosis in infants under 6 months of age and short and medium term follow-up

作　　者：罗芳[1] 徐玮泽[2] 夏呈森[2] 施丽萍[1] 吴秀静[1] 马晓路[1] 陈正[1] 

机构地区：[1]浙江大学医学院附属儿童医院新生儿重症监护病房,杭州310003 [2]浙江大学医学院附属儿童医院胸外科,杭州310003

出　　处：《中华儿科杂志》2011年第1期17-20,共4页Chinese Journal of Pediatrics

摘　　要：目的 探讨经皮球囊肺动脉瓣扩张成形术（percutaneous balloon pulmonary valvuloplasty,PBPV）治疗新生儿和6月龄以下小婴儿危重型肺动脉瓣狭窄（critical pulmonary stenosis,CPS）的疗效以及早中期随访.方法 采用PBPV治疗34例日龄波动于13～175 d的新生儿以及小婴儿CPS,并进行了6个月～4年的临床随访.记录患儿PBPV前后右室收缩压（right ventricular systolic pressure,RVSP）,肺动脉瓣跨瓣压差（transvalvular peak to peak systolic gradient,△P）以及PBPV术后采用心脏彩色多普勒动态监测的肺动脉瓣跨瓣压差的动态变化.结果 34例中32例（94%）完成PBPV术,1例术后2 h内死亡,2例心包积血,3例术中小球囊预扩张后换用合适球囊完成PBPV术,3例右室流出道痉挛,1例术后30 min右下肢股动脉搏动减弱.28例PBPV成功,RVSP由（96±28）mm Hg（1 mm Hg=0.133 kPa）下降至（49±20）mm Hg（下降49%,P＜0.01）,△P由（89±25）mm Hg下降到（25±12）mm Hg（下降72%,P＜0.01）,右室/主动脉收缩比值1.2±0.5下降到0.7±0.3（P＜0.01）.随访6个月～4年,3例失访,5例（其中3例新生儿）因残余压超过40 mm Hg行第二次PBPV术,23例彩色多普勒心脏超声监测肺动脉瓣跨瓣压有进一步下降到（20±13）mm Hg,无明显的肺动脉瓣反流,无需进一步处理.结论 对于6个月以下小婴儿CPS,PBPV仍有效,安全的治疗方法并具有相对好的短中期疗效.Objective To evaluate the effect and results of short and medium periods of follow-up of percutaneous balloon pulmonary valvuloplasty for critical pulmonary stenosis of neonates and infants under 6 months of age. Methods Between January 2002 and December 2008, 34 consecutive patients aged from 13to 175 days with critical pulmonary valvular stenosis underwent percutaneous balloon valvuloplasty. Patients records, catheterization data, angiograms and echocardiograms were reviewed. Patients were followed up for 6 months to 4 years （ mean 25.5 months ） by means of clinical examination and Doppler echocardiography.Results The pulmonary valvuloplasty was accomplished in 32 （94%） of 34 attempts. Immediately after dilation, right ventricular systolic pressure （RVSP） decreased from （96 ±28） mm Hg （ 1 mm Hg =0. 133kPa ） （49 ± 20 ） mm Hg （ P 〈 0. 01 ）, the transvalvular peak to peak systolic gradient （△P） decreased from （89±25） mm Hg to （25 ± 12） mm Hg （P 〈0.01 ）, and the right ventricular/aortic systolic pressure ratio decreased from 1.2 ± 0. 5 to 0. 7 ± 0. 3 （ P 〈 0. 01 ）. One patient died because of cardiac tamponade following rupture of the pulmonary valve annulus, 2 patients developed pericardial effusion, 3 patients had infundibular spasm, 3 patients had a pre-dilation by small balloon and 1 patient had weakened femoral artery pollex. After a follow up period of 6 months to 4 years 3 of 31 patients lost to follow-up. Repeat valvuloplasty was performed in 5 patients （3 neonates）, no patient required surgery, and the other 23 patients did not undergo further intervention, a mean peak systolic Doppler gradient of （20 ± 13） mm Hg was found and no significant pulmonary regurgitation was seen. Conclusions Percutaneous balloon pulmonary valvuloplasty was effective and safe for the treatment of critical pulmonary stenosis of neonates and infants under 6 months of age with good short and medium term results.

关 键 词：气囊扩张术 肺动脉瓣 肺动脉瓣狭窄 婴儿 新生 

分 类 号：R726.5[医药卫生—儿科]