经皮肺动脉瓣球囊扩张术临床应用30年疗效分析  

Long-term outcome of percutaneous balloon pulmonary valvuloplasty in the treatment of pulmonary valve stenosis for 30 years

作　　者：耿文磊 胡海波[1] 蒋世良[1] 徐仲英[1] 张戈军[1] 郑宏 赵世华[1] 金敬琳[1] 李世国[1] 吕建华[1] 徐亮 刘琼[1] 万俊义 潘湘斌[1] GENG Wen-lei;HU Hai-bo;JIANG Shi-liang;XU Zhong-ying;ZHANG Gejun;ZHENG Hong;ZHAO Shi-hua;JIN Jing-lin;LI Shi-guo;LV Jian-hua;XU Liang;LIU Qiong;WAN Jun-yi;PAN Xiang-bin(Department of Interventional Radiology,Fuwai Hospital,National Center for CardiovascularDiseases,Chinese Academy of Medical College and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]国家心血管病中心北京协和医学院中国医学科学院阜外医院结构性心脏病中心,北京100037

出　　处：《中国介入心脏病学杂志》2019年第3期157-161,共5页Chinese Journal of Interventional Cardiology

摘　　要：目的分析总结经皮肺动脉瓣球囊扩张术(PBPV)单中心临床应用30年治疗肺动脉瓣狭窄的临床价值及疗效。方法 1986年4月至2016年4月阜外医院共完成1229例PBPV,对其中临床资料完整的655例患者进行了6个月及以上的有效随访,随访时间为0.5～11.5年,平均(2.6±1.3)年,主要随访包括电话随访及门诊随访(以复查超声心动图为主)。结果 1229例患者术后即刻导管测量的跨瓣压差(PG)由术前(74.40±29.64)mmHg下降至(25.05±8.62)mmHg,下降明显(P<0.001),最后1次随访时超声心动图测量的平均PG维持在(21.91±17.22)mm Hg。PBPV成功率达到98.5%(1211/1229),发生术中及围术期死亡3例(死亡率0.2%),其他严重并发症(包括三尖瓣腱索断裂、肺动脉瓣重度反流)发生率为0.4%(5/1229)。超声心动图随访中3.1%(20/655)肺动脉瓣反流程度较术后24 h有所增加,再狭窄发生率为1.1%(7/655)。结论 30年的临床应用经验表明PBPV作为一种主要治疗单纯性肺动脉瓣狭窄的介入技术,其总体近、中、远期疗效满意,并发症发生率低,可作为一项瓣膜病微创治疗时代的主流技术继续应用于临床。Objective To evaluate the clinical application of percutaneous balloon pulmonary valvuloplasty(PBPV)in the treatment of pulmonary valve stenosis(PS)for 30 years in a single center.Methods Since April 1986 to April 2016,a total of 1229 PBPVs were performed in Fuwai Hospital,among whom,655 patients with complete clinical data were followed up for more than 6 months.The average follow-up time was(2.6±1.3)years(0.5 to 11.5 years),the main follow-up measures include telephone follow-up and outpatient follow-up(echocardiographic assessment).Results The pressure gradient(PG)measured by catheterization in 1229 patients significantly decreased from(74.40±29.64)mmHg before the procedure to(25.05±8.62)mmHg immediately after the procedure,with an obvious dropping(P<0.05).During the subsequent follow-up,the last PG measured by ultrasound was maintained at(21.91±17.22)mmHg on average.If the technical success criteria are PG<35 mmHg immediately after PBPV or a drop of more than 60%of PG,the technical success rate reaches 98.5%(1211/1229).There were 3 intraoperative and perioperative deaths(a mortality rate of 0.24%),and the incidence of other serious complications(including tricuspid valve rupture and more than moderate pulmonary regurgitation)was 0.4%(5/1229).At the time of echocardiographic follow-up,20 patients(3.0%)had an 1 degree increase in pulmonary valve regurgitation compared with 24 hours after operation.The incidence of restenosis was 0.5%(7/655)during follow-up.Conclusions Thirty years of clinical experience have shown that the PBPV as a main treatment for pulmonary stenosis has a satisfactory short,medium and long-term results,and the complication rates are low.Therefore,it can be considered as a mainstream technology in the era of interventional therapy for valvular diseases.An increase of the pulmonary regurgitation in a small number of patients during the follow-up requires further clinical investigation.

关 键 词：经皮肺动脉瓣球囊扩张术 肺动脉瓣狭窄 球囊成形术 

分 类 号：R542.54[医药卫生—心血管疾病] R654.2[医药卫生—内科学]