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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。
Objective To investigate the effect of different ball-valve ratio and balloon length on percutaneous balloon pulmonary valvuloplasty (PBPV) in short-term and mid-long term, and to explore the most suitable ball-valve ratio and balloon length. Methods From January 1987 to December 2005, pediatric patients with pulmonary valve stenosis in Shandong Provincial Hospital were enrolled in this study. PBPV was performed with dilatation balloon with different ball valve ratio and length. The peak pressure gradient between the right ventricle and pulmonary artery was measured before and after dilation. Lateral right ventriculography, measuring the size of the annulus and observing the right ventricular outflow tract irritation. Preoperative and postoperative transthoracic echocardiography to assess the maximum transmural pulmonary valve pressure gradient, and observe the pulmonary valve morphology and reflux. Results After PBPV, the pressure drop across the pulmonary valve in patients with long-term and long-term decreased continuously and the rate of pressure drop did not increase with the increase of the ratio of the balloon to the pelvis. No pulmonary valve restenosis was found after operation All children had different degrees of pulmonary valve regurgitation, and the degree of reflux increased with time, and with a positive correlation between the ball-valve ratio. For younger children (≤ 6 years old), balloons with large ball valves and a length of ≥40 mm tend to cause right ventricular outflow tract spasm and tricuspid regurgitation. The occurrence of tricuspid regurgitation in the middle and long term may be indirectly secondary to pulmonary valve regurgitation caused by right ventricular volume overload. Conclusions PBPV treatment of pulmonary valve stenosis, the best ball to valve ratio of 1.0 to 1.2, with satisfactory results and fewer complications; children under 6 years of age should use a balloon length of <40mm, can reduce the right ventricular outflow tract spasm and the recent tricuspid valve The occurrence of reflux.