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目的探讨重度先天性肺动脉瓣狭窄(PS)患者施行经皮球囊肺动脉瓣成形术(PBPV)的方法改进和注意事项,并总结其疗效。方法重度PS患者,因右心导管不能通过瓣口或当通过时出现缺氧性昏厥、抽搐及呼吸骤停,故采用Inoue球囊导管、参考经皮球囊二尖瓣成形术(PBMV)时球囊导管通过房间隔的方法,并加以改良通过肺动脉瓣口行PBPV。结果17例均获得有效扩张,PBPV后右心室压(RVP)由(133±29)mm Hg(1mm Hg=0.133kPa)下降至(45±13)mm Hg,差异有统计学意义(P<0.01),肺动脉瓣跨瓣压差(PVG)从(89±28)mm Hg下降至(21±11)mm Hg,差异有统计学意义(P<0.01),肺动脉瓣口面积(PVA)则由(0.62±0.31)cm2增大至(1.98±0.38)cm2,差异有统计学意义(P<0.01),肺动脉压没有显著改变,差异无统计学意义(P>0.05)。临床症状、体征改善,平均随访(106±26)个月无再狭窄发生。结论对特别严重的PS患者,采用Inoue球囊导管、参考PBMV时球囊导管通过房间隔的方法,并加以改良通过肺动脉瓣口能够获得满意的有效扩张,操作便捷、安全。
Objective To investigate the improvement and precautions of percutaneous balloon pulmonary valvuloplasty (PBPV) in patients with severe congenital pulmonary stenosis (PS) and to summarize its curative effect. Methods Severe PS patients, because of right heart catheterization can not pass through the valve orifice or when passing hypoxemic syncope, convulsions and respiratory arrest, so the use of Inoue balloon catheter, percutaneous balloon mitral valvuloplasty (PBMV) The balloon catheter was passed through the atrial septum and modified to pass PBPV through the pulmonary valve. Results All the patients achieved effective dilatation. The RVP decreased from (133 ± 29) mm Hg (1 mm Hg = 0.133 kPa) to (45 ± 13) mm Hg after PBPV (P <0.01) (PVG) decreased from (89 ± 28) mm Hg to (21 ± 11) mm Hg, the difference was statistically significant (P <0.01). The pulmonary valve area (PVA) 0.62 ± 0.31) cm2 to (1.98 ± 0.38) cm2, the difference was statistically significant (P <0.01), pulmonary arterial pressure did not change significantly, the difference was not statistically significant (P> 0.05). Clinical symptoms and signs were improved with no restenosis after an average follow-up of (106 ± 26) months. Conclusions In patients with particularly severe PS, the Inoue balloon catheter, the balloon catheter through the atrial septum with reference to PBMV, and the improvement through the pulmonary valve orifice can achieve satisfactory and effective dilatation, which is convenient and safe to operate.