CAJ | 학술논문

目的探讨使用超声心动图作为唯一影像学工具进行经皮肺动脉瓣球囊成形术的有效性和安全性.方法 2013年2月至2014年5月,我院治疗先天性肺动脉瓣狭窄患儿20例,年龄(7.9±3.0)岁,体重(26.7±7.6)kg,术前经胸超声心动图测肺动脉瓣跨瓣压差(62.9±11.9)mmHg,肺动脉瓣瓣环直径(14.5±1.5)mm.患儿均全身麻醉气管插管后,在经食管超声及经胸超声混合引导下行经皮肺动脉瓣球囊成形术.球囊直径为肺动脉瓣环直径1.2～1.5倍.球囊扩张后,通过导管测压并进行超声检查评价治疗效果.术后1个月门诊行经胸超声心动图进行随访.结果 20例患儿均成功在超声引导下完成肺动脉瓣球囊扩张术,球囊直径(19.9±2.3)mm,球囊直径与肺动脉瓣环直径比为1.37±0.06,术后即刻肺动脉瓣跨瓣压差为(15.5±4.3)mmHg.2例患儿出现肺动脉瓣少量反流.所有患儿存活,无外周血管损伤及心脏穿孔等并发症.住院时间为(3.5±0.8)d.术后1个月随访时经胸超声心动图测肺动脉瓣跨瓣压差为(16.3±4.7)mmHg.结论超声心动图引导下经皮介入治疗肺动脉瓣狭窄不仅安全有效,而且能避免放射线及造影剂的损伤.
목적 탐토사용초성심동도작위유일영상학공구진행경피폐동맥판구낭성형술적유효성화안전성.방법 2013년2월지2014년5월,아원치료선천성폐동맥판협착환인20례,년령(7.9±3.0)세,체중(26.7±7.6)kg,술전경흉초성심동도측폐동맥판과판압차(62.9±11.9)mmHg,폐동맥판판배직경(14.5±1.5)mm.환인균전신마취기관삽관후,재경식관초성급경흉초성혼합인도하행경피폐동맥판구낭성형술.구낭직경위폐동맥판배직경1.2～1.5배.구낭확장후,통과도관측압병진행초성검사평개치료효과.술후1개월문진행경흉초성심동도진행수방.결과 20례환인균성공재초성인도하완성폐동맥판구낭확장술,구낭직경(19.9±2.3)mm,구낭직경여폐동맥판배직경비위1.37±0.06,술후즉각폐동맥판과판압차위(15.5±4.3)mmHg.2례환인출현폐동맥판소량반류.소유환인존활,무외주혈관손상급심장천공등병발증.주원시간위(3.5±0.8)d.술후1개월수방시경흉초성심동도측폐동맥판과판압차위(16.3±4.7)mmHg.결론 초성심동도인도하경피개입치료폐동맥판협착불부안전유효,이차능피면방사선급조영제적손상.
Objective To assess the efficacy and safety of percutaneous balloon pulmonary valvuloplasty solely under echocardiographic guidance.Methods From February 2013 to May 2014,20 patients of congenital pulmonary valve stenosis were recruited.Their mean age was (7.9 ± 3.0)years and mean body weight (26.7 ± 7.6) kg.The pressure gradient across pulmonary valve was (62.9 ± 11.9) mmHg and annulus diameter (14.5 ± 1.5) mm which were measured by transthoracic echocardiography before procedure.All patients underwent percutaneous balloon pulmonary valvuloplasty by transesophageal and transthoracic echocardiographic guidance under general anesthesia and endotracheal intubation.The range of balloon/annulus ratio was 1.2-1.5.The outcomes of valvuloplasty were evaluated by catheter measuring and echocardiography after procedure.Follow-up was conducted by transthoracic echocardiography at 1 month after procedure.Results All cases were successfully treated with percutaneous balloon pulmonary valvuloplasty under echocardiographic guidance.The balloon diameter was (19.9 ± 2.3) mm,balloon/annulus ratio 1.37 ± 0.06 and postoperative pulmonary transvalvular pressure (15.5 ± 4.3) mmHg.Mild pulmonary valve regurgitation occurred in 2 patients.All patients survived without peripheral vascular damage or cardiac perforation.Hospitalization duration was (3.5 ± 0.8) days.During follow-up,pulmonary transvalvular pressure measured by transthoracic echocardiography was (16.3 ± 4.7) mmHg.Conclusions Echocardiography-guided percutaneous balloon pulmonary valvuloplasty is both safe and effective so that it avoids the injuries of radiation and contrast agents.