Percutaneous Transluminal Pulmonary Valvuloplasty for Severe to Critical Valvular Pulmonary Stenosis in Neonates and Infants

經皮心導管肺動脈瓣膜擴張術治療新生兒及嬰幼兒重度肺動脈瓣膜狹窄

李孟倫(Meng-Luen Lee) ； 王主科(Jou-Kou Wang)

《Acta Paediatrica Taiwanica》 45卷4期 (2004/08) Pp. 224-228

https://doi.org/10.7097/APT.200408.0224

摘要

本研究主要目的在針對經皮心導管肺動脈瓣膜擴張術(PTPV)治療新生兒及嬰幼兒重度肺脈動瓣膜狹窄的臨床經驗作一報告。自1997年5月至2003年5月，本研究共有7位病人患有重度肺動脈瓣膜狹窄，年齡自2天至6個月大。本研究不包括肺動脈閉鎖合併完整的心室中隔，及複雜性肺動脈瓣膜狹窄。我們在7位病人使用單一氣球導管進行PTPV，該氣球導管其充氣直徑比病人的肺動脈膜環大20%至40%。在實施PTPV之前，肺動脈瓣膜狖以杜卜勒心臓超音波測得的壓力差介於80至96毫米汞柱（平均85.0±5.4毫米汞柱）。以心導管回拉測得的壓力差介於80至119毫米汞柱（平均92.3±14.2毫米汞柱）。實施PTPV之後，以心導管回拉測和的壓力差介於13至40毫米汞柱（平均24.9±10.1毫米汞柱）（P值小於0.05），24小時內以杜蔔勒心臟超音波測得的壓力差介於15至28毫米汞柱（平均20.6±5.3毫米汞柱）（p值小於0.05）。在實施PTPV之前，右心室收宿壓和左心室收宿壓的比值介於1.0至1.6（平均1.2±0.2）；在實施PTPV之後，比值介於0.4至0.7（平均0.5±0.1）（p值小於0.05）。術後3個月以杜蔔勒心臟超音波追蹤其壓力差介於14至27毫米汞柱（平均19.3±5.3毫米汞柱）。我們認爲新生兒及嬰幼兒患有重度肺動脈瓣膜狹窄，實施PTPV可以達到很好的成功率，而沒有後遺症。

關鍵字

肺動脈瓣膜狹窄 ； 經皮心導管肺動脈瓣膜擴張術 ； 新生兒 ； 嬰幼兒

並列摘要

The aim of this study was to report the experience of percutaneous transluminal pulmonary valvuloplasty (PTPV) in neonates and infants with severe to critical valvular pulmonary stenosis. From May 1997 to May 2002, a total of 7 consecutive patients, aged 2 days to 6 months, with severe to critical valvular pulmonary stenosis were enrolled in this retrospective study. Patients having pulmonary atresia with intact interventricular septum, and pulmonary stenosis complicated with other cardiac malformations were excluded from this study. We performed PTPV in all 7 patients by using a single balloon catheter, with a diameter 20% to 40% larger than that of the pulmonary annulus. The pressure gradients across the pulmonary valve ranged from 80 to 96 mmHg (mean 85.0±5.4) by Doppler echocardiography, and ranged from 80 to 119 mmHg (mean 92.3±14.2) by pullback pressure tracings at cardiac catheterization before FTP V. After PTPV, the pressure gradients ranged from 13 to 40 mmHg (mean 24.9±10.1) by immediate pullback pressure tracings (p＜0.05), and ranged from 15 to 28 mmHg (mean 20.6±5.3) by Doppler echocardiography within 24 hrs (p＜0.05). The ratio of systolic pressure of the right ventricle to that of the left ventricle (sRV/sLV) ranged from 1.0 to 1.6 (mean 1.2±0.2) before PTPV, and ranged from 0.4 to 0.7 (mean 0.5±0.1) after PTPV (p＜0.05). At follow-up 3 months after PTPV, the Doppler echocardiographic pressure gradients ranged from 14 to 27 mmHg (mean 19.3±5.3). We conclude that PTPV can attain an excellent success rate in infants and neonates with severe to critical valvular pulmonary stenosis without sequelae.

並列關鍵字

valvular pulmonary stenosis ； percutaneous transluminal pulmonary valvuloplasty ； neonate ； infant