单纯超声引导下经皮肺动脉瓣球囊成形术的应用研究  

Application of percutaneous balloon pulmonary valvuloplasty under echocardiographic guidance

作　　者：潘湘斌[1] 胡盛寿[1] 欧阳文斌[1] 张凤文[1] 张大伟[1] 刘垚[1] 郭改丽[1] 逄坤静[1] 

机构地区：[1]中国医学科学院北京协和医学院,国家心血管病中心,阜外心血管病医院心脏外科,北京100037

出　　处：《中华小儿外科杂志》2015年第4期286-288,共3页Chinese Journal of Pediatric Surgery

基　　金：北京高等学校“青年英才计划”（YETP-1237）;高等学校博士学科点专项科研基金新教师类资助课题（2013-GB03）

摘　　要：目的探讨使用超声心动图作为唯一影像学工具进行经皮肺动脉瓣球囊成形术的有效性和安全性。方法2013年2月至2014年5月，我院治疗先天性肺动脉瓣狭窄患儿20例，年龄（7．9±3．O）岁，体重（26．7±7．6）kg，术前经胸超声心动图测肺动脉瓣跨瓣压差（62．9±11．9）mmHg，肺动脉瓣瓣环直径（14．5±1．5）mm。患儿均全身麻醉气管插管后，在经食管超声及经胸超声混合引导下行经皮肺动脉瓣球囊成形术。球囊直径为肺动脉瓣环直径1．2～1．5倍。球囊扩张后，通过导管测压并进行超声检查评价治疗效果。术后1个月门诊行经胸超声心动图进行随访。结果20例患儿均成功在超声引导下完成肺动脉瓣球囊扩张术，球囊直径（19．9±2．3）mm，球囊直径与肺动脉瓣环直径比为1．37±0．06，术后即刻肺动脉瓣跨瓣压差为（15．5±4．3）mmHg。2例患儿出现肺动脉瓣少量反流。所有患儿存活，无外周血管损伤及心脏穿孔等并发症。住院时间为（3．5±0．8）d。术后1个月随访时经胸超声心动图测肺动脉瓣跨瓣压差为（16．3±4．7）mmHg。结论超声心动图引导下经皮介入治疗肺动脉瓣狭窄不仅安全有效，而且能避免放射线及造影剂的损伤。Objective To assess the efficacy and safety of percutaneous balloon pulmonary valvuloplasty solely under echocardlographic guidance. Methods From February 2013 to May 2014, 20 patients of congenital pulmonary valve stenosis were recruited. Their mean age was （7. 9 ±3.0） years and mean body weight （26. 7± 7. 6） kg. The pressure gradient across pulmonary valve was （62. 9± 11.9） mmHg and annulus diameter （14. 5 ± 1.5） mm which were measured by transthoracic echocardiography before procedure. All patients underwent percutaneous balloon pulmonary valvuloplasty by transesophageal and transthoracic echocardiographic guidance under general anesthesia and endotracheal intubation. The range of balloon/annulus ratio was 1.2-1.5. The outcomes of valvuloplasty were evaluated by catheter measuring and echocardiography after procedure. Follow-up was conducted by transthoracic echocardiography at 1 month after procedure. Results All cases were successfully treated with percutaneous balloon pulmonary valvuloplasty under echocardiographic guidance. The balloon diameter was （19. 9±2. 3） mm, balloon/annulus ratio 1.37 ±0. 06 and postoperative pulmonary transvalvular pressure （15.5± 4. 3） mmHg. Mild pulmonary valve regurgitation occurred in 2 patients. All patients survived without peripheral vascular damage or cardiac perforation. Hospitalization duration was （3. 5 ± 0. 8） days. During follow-up, pulmonary transvalvular pressure measured by transthoracic echocardiography was （16. 3 ±4. 7 ） mmHg. Conclusions Echocardiography-guided percutaneous balloon pulmonary valvuloplasty is both safe and effective so that it avoids the injuries of radiation and contrast agents.

关 键 词：肺动脉瓣狭窄 经皮球囊肺动脉瓣成形术 超声心动图 

分 类 号：R726.5[医药卫生—儿科]