经皮球囊瓣膜成形术治疗先天性主动脉瓣狭窄
Percutaneous balloon aortic valvuloplasty in the treatment of congenital valvular aortic stenosis in children
摘要目的为研究评价先天性主动脉瓣狭窄(AS)球囊瓣膜成形术(PBAV)的效果。方法于1986年12月-1999年8月应用PBAV术治疗了27例AS病人,年龄2.5-12岁(平均6.09±2.26岁)。PBAV术球/瓣比值:发育良好型者(19例)为0.95±0.08;发育不良型(8例)则为1.00±0.11。术前后测定左室和升主动脉压力及跨主动脉瓣压力阶差(△P)。出院后多普勒超声心动图随访以监测跨主动脉瓣△P。结果发育良好型者15例(占78.9%)即刻效果良好,随访中有4例(26.7%)△P回复至50 mm Hg以上;发育不良型4例(占50%)效果良好,其中随访中有3例回升(占75.0%)。27例PBAV后无一例有轻度以上主动脉瓣返流及其它并发症。结论PBAV术是一种对AS有效、安全的替代外科瓣膜切开的介入性治疗方法,而且发育良好型AS较发育不良型效果好。
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abstractsObjective To assess the effect of the balloon valvuloplasty for congenital valvular aortic stenosis (AS) in children.Methods A total of 27 (mean age 6.09 years) children with AS accepted the treatment of percutaneous balloon aortic valvuloplasty (PBAV). The ratios of balloon/valve were 0.95 ± 0.08 for 19 cases of typical AS and 1.00 ± 0.11 for 8 cases of hypoplastic AS. The patients were evaluated by the gradients across aotic valves in pre- and post-PBAV and by echocardiogram during the follow-up period.Results Fifteen of 19 (78.9%)cases of typical AS had a batter outcome and the gradient of the remaining 4 cases (26.7%) had increased after follow-up (△P > 50 mm Hg) . Four of 8 (50.0%) cases of hypoplastic AS had satisfactory responses and the gradient of the remaining 3 cases (75.0%) rose. There was no moderate to severe aortic insufficiency (Al).Conclusion The balloon aortic valvuloplasty provides safe and significant hemodynamic and clinical improvement in pediatric patients. The outcome of PBAV for typical AS is better than for hypoplastic AS.
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