Balloon dilatation of critical stenosis of the pulmonary valve in neonates.
Balloon dilatation of critical stenosis of the pulmonary valve in neonates.
复制标题
新生儿肺动脉瓣严重狭窄的球囊扩张。
DOI：
10.1136/hrt.63.6.362
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发表时间：
1990
影响因子：
--
通讯作者：
M. Tynan
中科院分区：
文献类型：
--
作者：
E. J. Ladusans;S. A. Qureshi;J. Parsons;S. Arab;E J Baker;M. Tynan
对 15 名肺动脉瓣严重狭窄的新生儿（平均年龄 7.3（范围 1-27）天，体重 3.2（范围 2.5-4.1）kg）尝试经皮球囊扩张。 11 名患者 (73%) 扩张成功。平均球囊与环空比为1.1（范围0.6-1.77）。右心室与股动脉收缩压之比从扩张前的平均 (1 SD) 1.4 (0.32) 降至扩张后的 0.8 (0.24)，跨瓣膜压差从扩张前的 81 (29.7) mm Hg 降至扩张后的 33 (27.7) mm Hg。所有四名（27%）扩张不成功的患者均接受了手术瓣膜切开术。三名 (20%) 患者出现球囊扩张并发症；其中包括腹膜后血肿（一）和髂股静脉闭塞（二）。一名 (7%) 患者在导丝和球囊导管穿过瓣膜时出现严重缺氧和低血压。尽管扩张成功，他还是在手术后 7 天死亡。在平均 (1 SD) 2 (1.7) 年随访期间，11 名患者中的 7 名 (64%) 没有出现严重的再狭窄。一名患者在初次手术后三周需要重复扩张。三名 (27%) 患者在扩张后 4-9 个月出现再狭窄，三名患者均接受了瓣膜切开术。在最初转诊接受手术的四名患者中，三名需要进行第二次手术，一名需要球囊扩张。经皮球囊扩张可以有效缓解大多数新生儿的严重肺动脉狭窄，但需要手术的并发症和再狭窄很常见。
Percutaneous balloon dilatation was attempted in 15 consecutive neonates (mean age 7.3 (range 1-27) days and weight 3.2 (range 2.5-4.1) kg) with critical stenosis of the pulmonary valve. Dilatation was successful in 11 (73%) patients. The mean balloon to annulus ratio was 1.1 (range 0.6-1.77). The ratio of right ventricle to femoral artery systolic pressure decreased from a mean (1 SD) of 1.4 (0.32) before to 0.8 (0.24) after dilatation and the transvalvar gradient decreased from 81 (29.7) mm Hg before to 33 (27.7) mm Hg after dilatation. All four (27%) patients in whom dilatation was unsuccessful underwent surgical valvotomy. Complications of balloon dilatation occurred in three (20%) patients; these included retroperitoneal haematoma (one) and iliofemoral venous occlusion (two). In one (7%) patient severe hypoxia and hypotension developed when the valve was crossed with a guide wire and balloon catheter. Despite successful dilatation he died 7 days after the procedure. During a mean (1 SD) follow up of 2 (1.7) years, seven (64%) of the 11 patients remained free of important restenosis. One patient required repeat dilatation three weeks after the initial procedure. In three (27%) patients restenosis developed 4-9 months after dilatation and all three had surgical valvotomy. Of the four patients initially referred for surgery three required a second operation and one required balloon dilatation. Percutaneous balloon dilatation gave effective relief of critical pulmonary stenosis in most neonates but complications and restenosis requiring surgery were common.