何芊蓓,李侨,李怡坚,李锐韬,柴博峰,陈智成,俞之翔,赵振刚,冯沅

• 1:四川大学华西医院心脏内科

摘要(Abstract)：

目的 探讨经皮肺动脉瓣置入术（PPVI）的长期疗效及国产自膨胀式瓣膜（Venus P的耐久性。方法 前瞻性纳入2014年10月至2016年7月于四川大学华西医院就诊、经评估适合通过自膨胀式瓣膜进行PPVI治疗的外科术后右心室流出道（RVOT）功能障碍患者共8例，均使用VenusP瓣膜进行PPVI治疗。记录患者的临床、影像和手术资料、手术效果及随访结果。评估8例患者的生存率、术后围术期及远期并发症发生率、PPVI的远期疗效及Venus P的远期功能。即刻效果主要以临床瓣膜置入成功率评价，定义为瓣膜顺利置入且术后超声心动图评估的肺动脉瓣反流程度在中度以下、肺动脉瓣峰值压差<40 mmHg。结果 8例患者，其中7例女性，年龄14～36岁。初始诊断包括法洛四联症外科术后5例，法洛三联症外科术后1例，肺动脉瓣四叶瓣狭窄外科术后1例，右心室双出口外科术后1例。干预指征包括RVOT-肺动脉瓣狭窄合并反流（1例）及单纯反流（7例）。8例患者均临床置入成功，随访期间瓣膜在位，功能稳定，未发生瓣膜脱落、移位、支架断裂。术后患者症状均明显改善，术后6个月心脏磁共振成像测得右心室舒张末期容积指数（RVEDVi）相比术前明显下降[（89.99±13.85）ml/m~2比（144.93±11.28）ml/m~2,P=0.001]，术后肺动脉瓣反流程度均显著改善或消失，术前及末次随访超声检查测量的跨肺动脉瓣压差的差异无统计学意义[（23.25±8.39）mmHg比（18.75±6.28）mmHg,P=0.210]。8例患者平均随访（9.25±0.71）年，1例患者术后第5年发生感染性心内膜炎，无死亡、心力衰竭恶化、恶性心律失常等并发症，无患者再次手术。所有患者均已完成8年随访，其中3例已完成10年随访，最近1次随访时评估纽约心脏病协会（NYHA）心功能分级均为Ⅰ级。结论 对于解剖条件合适的外科术后RVOT-肺动脉功能障碍患者，使用国产自膨胀式瓣膜VenusP进行PPVI是可行的治疗方案，本研究从多角度证实该瓣膜具有较好的长期疗效和耐久性，在无预支架置入固有RVOT的情况下未发生严重支架断裂。

关键词(KeyWords)： 肺动脉瓣反流;自膨胀式瓣膜;前瞻性长期随访

Abstract:

Keywords:

基金项目(Foundation): 四川省科技厅重大科技专项项目（2022ZDZX0030）

作者(Author): 何芊蓓,李侨,李怡坚,李锐韬,柴博峰,陈智成,俞之翔,赵振刚,冯沅

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