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目的:探讨经皮球囊肺动脉瓣成形术(PBPV)治疗小婴儿和新生儿肺动脉瓣狭窄的疗效。方法:选取2013年10月至2014年10月接受PBPV的患儿12例,年龄6~169(106±46)d,体质量4.5~8.6(6.7±1.3)kg。首先右心导管分别测量患儿右心房、右心室及肺动脉压力,危重小婴儿先用小球囊预扩张肺动脉瓣,然后用单球囊法扩张肺动脉瓣,球囊径/瓣环径比值为(1.0±0.1)。术后采用超声心动图评价疗效。结果:所有患儿均成功实施PBPV,平均右室收缩压由术前(110±28)mm Hg下降至术后的(53±16)mm Hg(P<0.01),跨肺动脉瓣压力阶差由术前(84±26)mm Hg下降至术后的(25±13)mm Hg(P<0.01)。无严重并发症及死亡病例发生,随访1~12个月,患儿跨肺动脉瓣压力阶差基本保持稳定,术后1个月为(24±13)mm Hg,仅1例残余肺动脉瓣狭窄,无明显肺动脉瓣反流。结论:PBPV在小婴儿和新生儿重度肺动脉瓣狭窄中应用安全可行,选择合适大小球囊是介入治疗成功的重要环节。
Objective: To investigate the effect of percutaneous balloon pulmonary valvuloplasty (PBPV) on pulmonary stenosis in infants and neonates. Methods: Twelve children with PBPV were recruited from October 2013 to October 2014, ranging in age from 6 to 169 (106 ± 46) days and weighing from 4.5 to 8.6 (6.7 ± 1.3) kg. First right heart catheterization were measured in children with right atrium, right ventricle and pulmonary artery pressure, critically ill infants with small balloon pre-dilatation of the pulmonary valve, and then single balloon dilatation of the pulmonary valve, balloon diameter / valve ring diameter ratio of ( 1.0 ± 0.1). Postoperative echocardiography evaluation of efficacy. Results: The mean systolic pressure of right ventricular systolic pressure decreased from (110 ± 28) mm Hg preoperatively to (53 ± 16) mm Hg postoperatively in all children (P <0.01). The pressure gradient across the pulmonary valve was Preoperative (84 ± 26) mm Hg decreased to (25 ± 13) mm Hg after surgery (P <0.01). No serious complication and death occurred. The follow-up ranged from 1 to 12 months. The pressure gradient across the pulmonary valve remained stable with a mean of (24 ± 13) mm Hg one month after surgery and only 1 case of residual pulmonary valve stenosis, No obvious pulmonary valve regurgitation. Conclusion: PBPV is safe and feasible in the treatment of severe pulmonary stenosis in infants and neonates. Choosing the appropriate size balloon is an important step in the success of interventional therapy.