中国实用儿科杂志

中国实用儿科杂志

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球瓣比和球囊长度与儿童经皮球囊肺动脉瓣成形术疗效的关系

靳有鹏，王玉林，韩波，刘廷亮，张建军，庄建新，汪翼，马沛然，韩秀珍   

  1. 山东大学山东省立医院儿科，山东济南 250021
  • 收稿日期:2005-07-10 修回日期:2005-11-02 出版日期:2006-02-06 发布日期:2006-02-06

Influence of ratio of balloon to pulmonary artery annulus and length of balloon on the effect of percutaneous balloon pulmonary valvuloplasty in children.

Jin Youpeng,Wang Yulin,Han Bo,et al.   

  1. Shandong University Shandong Provincial Hospital,Jinan 250021,China
  • Received:2005-07-10 Revised:2005-11-02 Online:2006-02-06 Published:2006-02-06

摘要： 目的通过分析不同的球瓣比和球囊长度对儿童经皮球囊肺动脉瓣成形术(PBPV)近期及中远期疗效的影响，探讨最适宜的球瓣比和球囊长度。 方法1987~2005年山东省立医院儿科诊治119例肺动脉瓣狭窄患儿，使用不同球瓣比和长度的扩张球囊行PBPV术，扩张前后测量右室与肺动脉间的峰值压力阶差，并行左侧位右室造影，测量瓣环大小并观察有无右室流出道激惹。术前、术后定期行经胸超声心动图检查，估测最大跨肺动脉瓣压力阶差，并观察肺动脉瓣形态及其反流情况。 结果超大球囊法行PBPV术后，患儿的近期及中远期跨肺动脉瓣压差持续下降，且压差下降率不随球瓣比的增加而增大；术后未发现有肺动脉瓣再狭窄者，所有患儿均有不同程度的肺动脉瓣反流，且反流的程度随时间的延长而加重，并与球瓣比成正相关。对于年龄较小(≤6岁)的儿童，球瓣比大且长度≥40mm的球囊较易引起右室流出道痉挛及三尖瓣反流。中远期三尖瓣反流的发生可能间接继发于肺动脉瓣反流所引起的右室容量负荷过重。 结论PBPV治疗肺动脉瓣狭窄，最佳的球瓣比为1.0~1.2，疗效满意且并发症少；6岁以下儿童宜使用长度<40mm的球囊，可减少右室流出道痉挛及近期三尖瓣反流的发生。

关键词: 经皮球囊肺动脉瓣成形术, 球瓣比, 球囊长度

Abstract: AbstractObjectiveTo explore the effect of percutaneous balloon pulmonary valvuloplasty (PBPV) by various ratio of balloon diameter to pulmonary valve diameter(balloon/valve) and length of balloon in children. MethodsA total of 119 patients (aged 8.6±3.5 years) with pulmonary valve stenosis received PBPV.Peak systolic pressure gradients from the right ventricle to the pulmonary artery before and immediately after PBPV were measured by catheterization.The right ventricular cineangiogram was done before and immediately following dilation to measure the diameter of pulmonary valve annulus and observe the infundibular spazm.Doppler estimated the transvalvular pressure gradients before、24 hours、1 month、3 months、6 months、1 year and yearly after PBPV,respectively.Pulmonary artery regurgitation was observed by echocardiography. ResultsThe pressure gradients from the right ventricle to the pulmonary artery decreased continously after oversized percutaneous balloon pulmonary valvuloplasty in all patients.No significant correlation was found between the ratio of balloon/valve and pressure gradient decreasing rate.No restenosis occurred after PBPV.All cases developed pulmonary valve regurgitation and the degree correlated very well with ratio of balloon/valve.Higher ratio of balloon/valve and balloon length≥40mm led to the right ventricular infundibular spasm and triangular valve regurgitation,especially to children less than 6 years old.The triangular valve regurgitation which happened at mediate and long term after PBPV was perhaps due to the right ventricular volume overload. ConclusionThe best ratio of balloon/valve for PBPV was 1.0~1.2 with satisfying effects and less complications.The length of balloon less than 40mm is suitable for children less than 6 years old.

Key words: Ratio of balloon diameter to pulmonary valve diameter, Length of balloon