经皮球囊瓣膜成形术治疗儿童主动脉瓣狭窄的临床疗效观察  

Balloon valvuloplasty for congenital aortic valve stenosis in children

作　　者：吴琳[1] 齐春华[1] 何岚[1] 刘芳[1] 陆颖[1] 黄国英[1] 

机构地区：[1]复旦大学附属儿科医院心血管中心,上海201102

出　　处：《中华儿科杂志》2014年第9期699-702,共4页Chinese Journal of Pediatrics

摘　　要：目的 评价经皮球囊瓣膜成形术（PBAV）治疗儿童先天性主动脉瓣狭窄的疗效与安全性.方法 回顾性分析2006年10月至2012年12月在复旦大学附属儿科医院心血管中心接受PBAV的14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、心功能状况以及穿刺动脉损伤、主动脉瓣反流程度等并发症的发生情况.结果 14例患儿中男12例,女2例;年龄（17.1 ±10.5）个月（8d～6岁）;体重（8.9 ±5.5）kg （1.9 ～23.0 kg）.手术纳入标准为多普勒超声心动图测量主动脉瓣跨瓣峰值压差≥75 mmHg（1 mmHg=0.133 kPa）或峰值压差＜75 mmHg,伴有严重左心功能不全或心电图提示左心室心肌劳损.PBAV中选用的扩张球囊与主动脉瓣环直径比值为0.75 ～ 1.09,平均0.92±0.09;扩张术后,导管所测得收缩期跨瓣压差由术前（69±26） mmHg下降至（29±13） mmHg（t=7.628,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与平均压差分别由术前（95±21） mmHg和（50±7）mmHg下降至（49±16） mmHg和（24±11）mmHg（t =7.630,10.401; P=0.000,0.000）.术后随访1 d～61个月,2例（14％）因严重再狭窄而再次接受PBAV,并成功解除了残余狭窄,但其中1例再次成形术4年后因主动脉瓣再度狭窄合并中度反流行外科Ross术;3例术前伴有明显心功能不全症状的小婴儿中,1例术后第2天死亡,2例术后左心室收缩功能明显改善.术后出现中度及以上主动脉瓣反流仅1例（7％）,无其他手术相关并发症.结论 对于儿童先天性主动脉瓣狭窄,PBAV近期疗效佳,安全性高,可作为一种有效的姑息性治疗手段,推延儿童主动脉瓣的外科手术治疗.Objective To evaluate the efficacy and safety of percutaneous balloon aortic valvuloplasty（PBAV） for congenital aortic valve stenosis in children.Method This is a retrospective clinical study including 14 children treated with PBAV for congenital aortic valve stenosis from October 2006 to December 2012 in our institute.During clinical follow-up,aortic residual stenosis and restenosis,left ventricular function and the procedure-related complications,including the approach artery injury,and aortic regurgitation were particularly assessed.Result A total of 14 patients consisting of 12 boys and 2 girls underwent the procedure,with mean age （17.1 ± 10.5） months （range from 8 days to 6 years） and the mean body weight （8.9 ± 5.5） kg （range from 1.9 kg to 23.0 kg）.The indication for PBAV was a Doppler-derived peak instaneous gradient of ≥75 mmHg（1 mmHg =0.133 kPa） or a smaller gradient with signs of severe left ventricular dysfunction or left ventricular strain on the ECG.The mean ratio of balloon-annulus was 0.92 ± 0.09 （range from 0.75 to 1.09）.The catheter-measured peak systolic valve gradient was successfully relieved in all the patients,decreasing from （69 ± 26） mmHg to （29 ± 13） mmHg immediately after balloon valvuloplasty （t =7.628,P =0.000）.The Doppler-derived peak and mean gradient decreased from （95 ±21） mmHg and （50 ±7） mmHg to （49 ± 16） mmHg and （24 ± 11） mmHg,respectively（t =7.630,10.401 ; P =0.000,0.000）.The mean follow-up period was 1 day to 61 months.At follow-up,2 patients （2/14,14％） underwent the second balloon valvuloplasty for the significant restenosis,and both showed successful relief of restenosis,however 1 patient required surgical Ross procedure due to significant recurrent systolic pressure gradient and moderate aortic regurgitation 4 years after the second balloon valvuloplasty.Among the 3 young infants who presented with congestive heart failure before intervention,1 died 1 day after the procedure,the other 2 patients

关 键 词：主动脉瓣狭窄 心脏缺损 先天性 气囊扩张术 儿童 

分 类 号：R726.5[医药卫生—儿科]