不同介入术式治疗儿童先天性主动脉瓣狭窄  

Different interventions in treatment of children with congenital aortic stenosis

作　　者：孙春平 张智伟[1] 谢育梅[1] 钱明阳[1] 李俊杰[1] 谢兆丰[1] Sun Chunping;Zhang Zhiwei;Xie Yumei;Qian Mingyang;Li Junjie;Xie Zhaofeng(Guangdong Cardiovascular Institute,Department of Pediatric Cardiology,Guangdong Province People's Hospital,Guangdong Academy of Medical Science,Guangzhou 510100,China)

机构地区：[1]广东省心血管病研究所,广东省人民医院广东省医学科学院心儿科,广州510100

出　　处：《中华实用儿科临床杂志》2019年第1期38-42,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家重点研发计划项目(2016YFC1100300).

摘　　要：目的评估儿童经逆行途径、前向途径或有无右心室起搏行经皮球囊主动脉瓣成形(PBAV)术的安全性及有效性。方法回顾性分析2008年1月至2017年6月在广东省心血管病研究所接受PBAV术的32例先天性主动脉瓣狭窄患儿的临床资料,术后随访主动脉瓣残余狭窄与再狭窄、动脉损伤、主动脉瓣反流程度等并发症的发生情况。结果32例患儿中男27例,女5例;年龄(55.8±52.0)个月(20 d^15岁);体质量(18.2±14.0) kg(3.5~59.0 kg)。其中2例经股静脉顺行途径左心导管检查,1例有介入指征通过未闭卵圆孔行PBAV术,其余均为股动脉途径,24例右心室快速起搏。导管所测得的收缩期跨瓣压差由术前(81.6±28.0) mmHg(1 mmHg=0.133 kPa)下降至(41.4±19.0) mmHg,差异有统计学意义(t=9.543,P=0.000);术后次日多普勒超声测量收缩期主动脉瓣跨瓣峰值压差由术前(82.7±23.0) mmHg下降至(44.6±18.0) mmHg,差异有统计学意义(t=11.732,P=0.000)。术中测量主动脉瓣环直径(13.8±3.0) mm(6.5~21.0 mm),选择球囊直径(14.1±4.0) mm (6~23 mm)。术后随访1~72个月,术后次日多普勒超声测量收缩期主动脉瓣跨瓣峰值压差与随访比较差异有统计学意义[(44.6±18.0) mmHg比(58.6±30.0) mmHg,t=-2.549,P=0.016]。5例(14.7%)患儿PBAV术后因再狭窄或合并中至重度反流行外科手术。术后即刻新增轻度反流7例。1例术后第2天死亡,1例股动脉栓塞。结论随着PBAV术的步骤规范、多样化及介入器械的不断改良,PBAV术对于儿童先天性主动脉瓣狭窄可起到很好的缓解作用,并且安全性不断提高。Objective To evaluate the efficacy and safety of percutaneous balloon aortic valvuloplasty(PBAV) in retrograde, antegrade way or right ventricular pacing in children. Methods This was retrospective clinical study included 32 children who were treated with PBAV for congenital aortic stenosis from January 2008 to June 2017 in Guangdong Cardiovascular Institute.The general clinical data including residual stenosis and aortic stenosis again, and degree of artery injury, aortic regurgitation were particularly assessed. Results A total of 32 patients consisting of 27 boys and 5 girls underwent the procedure, with age of (55.8±52.0) months (ranging from 20 days to 15 years) and body weight (18.2±14.0) kg (ranging from 3.5 kg to 59.0 kg). Two infants accepted left cardiac catheterization through femoral vein and one with interventional indication then accepted PBAV through the patent foramen ovale.The others underwent the retrograde way, including 24 cases with rapid right ventricular pacing.The catheter-measured peak systolic the aortic valve gradient decreased from (81.6±28.0) mmHg(1 mmHg=0.133 kPa) to (41.4±19.0) mmHg immediately after percutaneous interventional treatment, and the difference was statistically significant(t=9.543, P=0.000). The peak systolic valve gradient mea-sured pre-PBAV and on the second day after PBAV measured by Doppler echocardiography decreased from (82.7±23.0) mmHg to (44.6±18.0) mmHg, and the difference was statistically significant(t=11.732, P=0.000). The diameters of the aortic valve were (13.8±3.0) mm(ranging from 6.5 mm to 21.0 mm) and the balloons were (14.1±4.0) mm(ranging from 6 mm to 23 mm). The follow-up period was 1 to 72 months.The peak systolic valve gradient measured by Doppler echocardiography increased from (44.6±18.0) mmHg to (58.6±30.0) mmHg, and the difference was statistically significant(t=-2.549, P=0.016). During the procedure, 5 children(14.7%) accepted surgery for restenosis or regurgitation.Seven had regurgitation, one had femoral artery embolism and one di

关 键 词：主动脉瓣狭窄 介入 儿童 

分 类 号：R726.5[医药卫生—儿科]