Neonatal critical valvar aortic stenosis. A comparison of surgical and balloon dilation therapy.
Neonatal critical valvar aortic stenosis. A comparison of surgical and balloon dilation therapy.
复制标题
新生儿危重主动脉瓣狭窄。
作者：
Benjamin Zeevi;J. F. Keane;Aldo R. Castaneda;S. Perry;James E. Lock
在婴儿和儿童中，球囊主动脉瓣切开术（BAV）是外科瓣膜切开术的替代方法。我们比较了16个连续新生儿（1985-1988）的BAV与16个连续新生儿（1978-1984）的先前组的外科瓣膜切开术。两组在年龄、体重、血流动力学数据、左心室大小和相关病变方面具有可比性。术后有6例早期死亡和1例晚期死亡。需要第二次手术的6名新生儿中有5名死亡。左心室大小（在13名新生儿中测量）对术后生存率有一定影响：3名左心室小或发育不全的新生儿和3名左心室大小正常的新生儿死亡。BAV后，有3例早期死亡，2例接受I期左心发育不全综合征姑息治疗的患者，2例晚期死亡。与外科瓣膜切开术一样，左心室大小似乎影响BAV后的生存率：6例左心室小或发育不良患者中有5例死亡或因左心发育不良综合征接受I期姑息治疗，9例左心室大小正常的患者中有2例死亡。手术组6例患者随访（26 +/- 17个月）时，收缩期峰值射血压差（PSEG）为52.2 +/- 23 mm Hg，左心室舒张末期压（LVEDP）为18.2 +/- 5.2 mm Hg。主动脉瓣返流为轻度5例，中度6例。在随访时（17.6 +/- 7.8个月），球囊扩张组9例患者的PSEG在导管插入术时为45.6 +/- 11 mm Hg，超声心动图-多普勒检查4例患者为43.8 +/- 22.9 mm Hg。主动脉瓣返流在3名患者中为轻度，在其他6名患者中不存在。（250字处删节）
Balloon aortic valvotomy (BAV) is an alternative to surgical valvotomy in infants and children. We compared BAV in 16 consecutive neonates (1985-1988) to surgical valvotomy in a prior group of 16 consecutive neonates (1978-1984). Both groups were comparable in terms of age, weight, hemodynamic data, left ventricular size, and associated lesions. There were six early and one late deaths after surgery. Five out of six neonates requiring a second operation died. Left ventricular size (measured in 13 neonates) had some influence on survival after surgery: three of three with small or hypoplastic left ventricles and three of 10 with normal-sized left ventricles died. After BAV, there were three early deaths, two patients who underwent stage I palliation of hypoplastic left heart syndrome, and two late deaths. As with surgical valvotomy, left ventricular size seemed to influence survival after BAV: five of six with small or hypoplastic left ventricles died or underwent stage I palliation for hypoplastic left heart syndrome and two of nine with normal-sized left ventricles died. At follow-up (26 +/- 17 months) in six patients in the surgical group, the peak systolic ejection gradient (PSEG) was 52.2 +/- 23 mm Hg and left ventricular end-diastolic pressure (LVEDP) 18.2 +/- 5.2 mm Hg. Aortic regurgitation was mild in five and moderate in the sixth patient. At follow-up (17.6 +/- 7.8 months) in nine patients in the balloon dilation group, the PSEG was 45.6 +/- 11 mm Hg in five patients at catheterization and 43.8 +/- 22.9 mm Hg in four patients by echocardiography-Doppler. Aortic regurgitation was mild in three and absent in the other six patients.(ABSTRACT TRUNCATED AT 250 WORDS)