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目的:为评价经皮球囊肺动脉瓣成形术治疗单纯性肺动脉瓣狭窄患者的即刻和远期效果及影响疗效的因素。方法:病例选择为自1999年1月至2005年12月行经皮肺动脉瓣球囊成形术治疗肺动脉瓣狭窄的患者,共39例。术前导管测肺动脉瓣收缩期峰值跨瓣压差为(65.6±29.8)mmHg。结果:术后导管测即刻肺动脉瓣跨瓣压差为(28.8±14.2)mmHg,跨瓣压差<36mmHg的患者31例,占79.5%。成功随访31例。超声心动图多普勒测跨瓣压差为(32.7±21.1)mmHg。随访时跨瓣压差<36mmHg,共25例,占80.6%。有4例患者出现不同程度再狭窄,其中2例再次行经皮肺动脉瓣球囊成形术,肺动脉瓣跨瓣压差降至36mmHg以下,其余2例继续观察。Logistic回归显示,影响肺动脉瓣球囊成形术长期疗效最主要的因素为术后即刻跨瓣压差,术后即刻跨瓣压差>36mmHg的患者,远期疗效相对较差。术中及随访时无严重不良并发症。结论:经皮肺动脉瓣球囊成形术安全、创伤小,但有小部分患者特别是术后即刻压差>36mmHg的患者易发生再次狭窄,术后应注意随访。
OBJECTIVE: To evaluate the immediate and long-term effects of percutaneous balloon pulmonary valvuloplasty in patients with simple pulmonary valve stenosis and the factors that influence the curative effect. Methods: The patients were selected from January 1999 to December 2005 percutaneous pulmonary valve balloon angioplasty in patients with pulmonary valve stenosis, a total of 39 cases. Preoperative catheter measured pulmonary valve systolic peak transvalvular pressure was (65.6 ± 29.8) mmHg. Results: Immediately after catheterization, pulmonary valve transvalvular pressure was (28.8 ± 14.2) mmHg, and transvalvular pressure <36mmHg in 31 patients (79.5%). Successful follow-up of 31 cases. Echocardiography Doppler transvalvular pressure difference was (32.7 ± 21.1) mmHg. Follow-up transvalvular pressure <36mmHg, a total of 25 cases, accounting for 80.6%. In 4 cases, restenosis occurred in varying degrees. Two of them underwent percutaneous pulmonary valvuloplasty again. The pressure difference of pulmonary valvuloplasty dropped below 36mmHg, and the remaining two cases were observed. Logistic regression showed that long-term efficacy of pulmonary valve balloon angioplasty is the most important long-term transvalvular pressure immediately postoperative transvalvular pressure> 36mmHg patients, the long-term efficacy is relatively poor. Intraoperative and follow-up without serious adverse complications. Conclusion: Percutaneous pulmonary valve balloon angioplasty is safe and less invasive. However, a small number of patients, especially those with pressure> 36mmHg immediately after the operation, are prone to be restenosed and should be followed up after operation.