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目的:分析经皮球囊肺动脉瓣成形术(PBPV)治疗单纯性肺动脉瓣狭窄(PS)的疗效,以提高治愈率,减少并发症。方法:回顾性分析2004年7月至2011年6月采用PBPV治疗的75例PS患儿的临床资料,比较扩张前后肺动脉和右心室压力变化以及球囊的选择情况、术后并发症。结果:75例PS患儿术前右心室收缩压为(70.24±23.54)mm Hg,术后即刻心导管检测降为(34.75±9.12)mm Hg(P<0.01);跨肺动脉瓣压力阶差(△P)术前为(49.41±22.57)mm Hg,术后即刻心导管检测降为(11.33±7.25)mm Hg(P<0.01),术后即刻心导管检测跨肺动脉瓣压力阶差<25 mm Hg达94.67%,术后24 h经超声测定△P为(23.04±9.80)mm Hg;术后1月、术后3月、术后6月及术后1年超声测定△P均较术后24 h明显下降;右心室造影肺动脉瓣环直径为(13.76±3.18)mm,所选球囊大小为(16.70±3.68)mm;无严重并发症和死亡病例发生。结论:PBPV治疗儿童PS安全有效。结合术前超声和右室造影判断肺动脉瓣环大小,选择合适大小球囊是介入成功的关键。
Objective: To analyze the curative effect of percutaneous balloon pulmonary valvuloplasty (PBPV) on simple pulmonary valve stenosis (PS) in order to improve the cure rate and reduce complications. Methods: The clinical data of 75 children with PS treated with PBPV from July 2004 to June 2011 were retrospectively analyzed. The changes of pulmonary artery and right ventricular pressure, balloon selection and postoperative complications were compared before and after dilation. Results: The preoperative right ventricular systolic pressure in 75 PS patients was (70.24 ± 23.54) mm Hg, and the postoperative cardiac catheterization was reduced to (34.75 ± 9.12) mm Hg (P <0.01). The pressure gradient across the pulmonary valve △ P) was (49.41 ± 22.57) mm Hg preoperatively, the heart catheterization decreased to (11.33 ± 7.25) mm Hg (P <0.01) immediately after the operation, and the cardiac pressure gradient across the pulmonary valve was less than 25 mm Hg up to 94.67%, 24 h after the ultrasound determination of △ P (23.04 ± 9.80) mm Hg; 1 month after surgery, 3 months after surgery, 6 months after surgery and 1 year after surgery, The diameter of pulmonary valve ring in right ventriculography was (13.76 ± 3.18) mm, and the size of the selected balloon was (16.70 ± 3.68) mm. No serious complication and death occurred. Conclusion: PBPV is safe and effective in children with PS. Combined with preoperative ultrasound and right ventricular angiography to determine the size of the pulmonary valve ring, select the appropriate size balloon is the key to successful intervention.