Balloon Pulmonary Valvuloplasty in Adults with Congenital Valvular Pulmonary Stenosis

成人先天性肺動脈瓣狹窄以氣球擴張術治療之效果

林斯晨(Sir-Chen Lin) ； 黃瑞仁(Juey-Jen Hwang) ； 許寬立(Kwan-Lih Hsu) ； 李啟明(Chii-Ming Lee) ； 王主科(Jou-Kou Wang) ； 曾春典(Chuen-Den Tseng)江福田(Fu-Tien Chiang,)廖朝崧(Chiau-Suong Liau)曾淵如(Yung-Zu Tseng)

《Acta Cardiologica Sinica》 20卷3期 (2004/09) Pp. 147-153

摘要

背景 先天性肺動脈瓣狹窄以氣球擴張術 (心臟瓣膜成型術) 治療在小兒科已經行之有年，本研究主要評估成人先天性肺動脈瓣狹窄以氣球擴張術治療之效果。
方法與結果 統計12 位接受氣球擴張術治療之成年病患 (平均41 歲，其中3 人高齡達68、71 及80 歲)，8 例為雙氣球，4 例為單氣球擴張術 (其中1 例使用Inoue 氣球)，分析其術前、術後及長期追蹤之血液動力學之各項參數。我們發現術後右心室收縮壓立即由101.4 ± 35.0減少為48.8 ± 17.7 毫米汞柱，肺動脈瓣壓力差立即由85.3 ± 37.3 減少為29.9 ± 20.0 毫米汞柱。十位病患以都普勒超音波追蹤 (平均68.6 個月)，肺動脈瓣壓力差逐漸減少為15.1 ± 11.9毫米汞柱。全部病患症狀皆穫得改善，而且沒有出現併發症。
結論 以氣球擴張術治療成人先天性肺動脈瓣狹窄，是十分安全又有效的治療方式，甚至施行於高齡老人也相當成功。

關鍵字

肺動脈瓣狹窄 ； 氣球擴張術 ； 成人

並列摘要

Background: Balloon valvuloplasty has been used for congenital valvular pulmonary stenosis (PS) in pediatric patients as a conventional treatment. The purpose of this study was to further investigate the safety, immediate and long-term results of balloon valvuloplasty in adults with congenital valvular pulmonary stenosis.
Method and Result:We analyzed hemodynamic data of 12 patients who underwent balloon pulmonary valvuloplasty (ages 20-80, mean 41 years). Double-balloon technique was used in 8 patients and single-balloon technique in 4 patients (including 1 case with Inoue balloon). Right ventricle systolic pressure and pulmonary valve peak-to-peak systolic pressure gradient decreased from 101.4 35.0 to 48.8 17.7 mmHg(p ＜ 0.001) and 85.3 37.3 to 29.9 20.0 mmHg (p ＜ 0.001), respectively. Ten patients underwent transthoracic Doppler echocardiography follow-up 2-184 months (mean 68.6 months) after pulmonary balloon valvuloplasty, and peak transvalvular systolic pressure gradient further decreased to 15.1 11.9 mmHg (p = 0.001). All patients had symptomatic improvement, and no major complication or mortality was noted.
Conclusion: Balloon pulmonary valvuloplasty is a safe and effective treatment for adult patients with congenital valvular PS. In our experience, even elderly patients (up to 80 years old) had satisfactory result.

並列關鍵字

Pulmonary stenosis ； Balloon valvuloplasty ； Adult