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目的:探讨经皮球囊肺动脉瓣成形术(PBPV),治疗肺动脉瓣狭窄(PS)及室间隔完整的肺动脉瓣闭锁(PA/IVS)的安全性及有效性。方法:我科自1987年4月至2011年5月收治的PS 202例,PA/IVS 2例,男性116例,女性88例,年龄3个月～40岁,平均4.25岁,体质量5～60 kg,平均(17.32±8.85)kg,发绀34例。完善心电图、心脏X线像、超声心动图检查,行右心导管检查及右心室造影并完成PBPV。结果:PBPV 204例,成功200例,成功率98%。PBPV术后,导管测肺动脉瓣跨瓣压差〔(30.84±15.05)mmHg(1 mmHg=0.133 kPa)〕较术前(75.75±30.04)mmHg明显下降,P=0.001。4例失败病例中,1例因右心室流出道狭窄导丝难以到达肺动脉,取消PBPV。第2例导丝送入肺动脉出现循环不稳定取消PBPV。第3例PA/IVS,射频打孔成功后球囊扩张时出现心包填塞,转外科手术。第4例术中球囊扩张时右心室流出道撕裂致心包填塞,抢救无效死亡。其中2例出现严重并发症,1例三尖瓣腱索断裂;1例缺血、缺氧性脑病。结论:PBPV治疗PS及PA/IVS安全有效。严格掌握适应证,规范操作可以减少并发症。
Objective: To investigate the safety and efficacy of percutaneous balloon pulmonary valvuloplasty (PBPV) in the treatment of pulmonary valve stenosis (PS) and complete ventricular septal pulmonary valve atresia (PA / IVS). Methods: From April 1987 to May 2011, 202 cases of PS and 2 cases of PA / IVS were treated in our department. There were 116 males and 88 females, aged 3 months to 40 years (average 4.25 years old, body weight 5 ~ 60 kg, mean (17.32 ± 8.85) kg, cyanosis in 34 cases. Complete ECG, cardiac X-ray, echocardiography, right heart catheterization and right ventricular angiography and complete PBPV. Results: 204 cases of PBPV, 200 cases of success, the success rate of 98%. After PBPV, the transvalvular pressure difference of pulmonary valve ([(30.84 ± 15.05) mmHg (1 mmHg = 0.133 kPa)] was significantly lower than that of preoperative (75.75 ± 30.04) mmHg, P = 0.001.4 Case due to stricture of the right ventricular outflow tract difficult to reach the pulmonary artery, remove PBPV. The second case of guide wire sent to the pulmonary artery loop instability cancel PBPV. The third case of PA / IVS, after the success of radio frequency drilling perforation of the balloon tamponade, turn surgery. The fourth case of intraoperative balloon dilatation of the right ventricular outflow tract tear caused by pericardial tamponade, rescue dead. Serious complications occurred in 2 cases, rupture of tricuspid chordae in 1 case, ischemic and hypoxic encephalopathy in 1 case. Conclusion: PBPV is safe and effective in the treatment of PS and PA / IVS. Strict control of indications, regulate the operation can reduce complications.