Objective: To evaluate the clinical efficacy of percutaneous balloon pulmonary valvuloplasty (PBPV) via antegrade venous-arterial loop in neonates with critical pulmonary stenosis with intact ventricular septum (CPS-IVS). Methods: A retrospective case review was conducted. Fifteen neonates with CPS-IVS who underwent PBPV via antegrade venous-arterial loop at the Women and Children's Hospital, Qingdao University between September 2020 and September 2023 were included. Pre-and post-operative right ventricular functional parameters, surgical complications, and follow-up outcomes were analyzed. Paired-sample t-test was used to compare changes in right ventricular systolic pressure (RVSP), percutaneous oxygen saturation (SpO2), and echocardiographic findings pre-and post-operatively, as well as during the follow-up period. Results: Among the 15 neonates (9 males and 6 females) with CPS-IVS, the surgical age was (3.6±0.5) d. All neonates underwent successful PBPV via antegrade venous-arterial loop under general anesthesia. The immediate post-operative trans-pulmonary valve pressure gradient was (35±6) mmHg (1 mmHg=0.133 kPa), with a significant reduction in RVSP from (96±16) mmHg to (59±14) mmHg (t=6.70, P<0.001). SpO2 (with an inspired oxygen concentration of 0.48) increased from 0.86±0.07 pre-operatively to 0.97±0.03 post-operatively (t=4.81, P<0.001). One month postoperatively, SpO2 (without oxygen supplementation) normalized in all patients, with a statistically significant difference compared to pre-operative values (t=0.16, P<0.001). Immediately postoperative, mild to moderate diastolic pulmonary valve regurgitation was observed in 8 patients, with no cases of severe regurgitation. Additionally, the severity of tricuspid valve regurgitation decreased from severe to mild-to-moderate in 6 patients. Three months postoperatively, one patient underwent a second PBPV due to an increased trans-pulmonary valve pressure gradient of 74 mmHg, which decreased to 27 mmHg immediately after the procedure, with subsequent good recovery. Over a one-year follow-up period, all 15 patients demonstrated improvements in right ventricular indices. The Z-score of the tricuspid valve annulus significantly improved from -1.9±0.8 pre-operatively to -0.4±0.1 post-operatively (t=6.88, P<0.001). At the last follow-up, mild to moderate pulmonary valve regurgitation was observed in 3 patients, and mild tricuspid regurgitation in 2 patients, with no cases of moderate or severe regurgitation. Conclusion: Intervention via antegrade venous-arterial loop for the treatment of CPS-IVS in neonates is safe and effective.
目的： 评价经顺行静动脉环路实施经皮球囊肺动脉瓣成形术（PBPV）治疗新生儿室间隔完整的危重型肺动脉瓣狭窄（CPS-IVS）的临床效果。 方法： 回顾性病例总结。选择2020年9月至2023年9月于青岛大学附属妇女儿童医院经顺行静动脉环路PBPV治疗的CPS-IVS患儿15例为研究对象，分析患儿手术前后右心室功能参数、手术并发症以及随访结局。比较手术前后右心室收缩压变化、手术前后与随访期间经皮血氧饱和度（SpO2）和超声心动图的变化，组间比较采用配对样本t检验。 结果： 15例CPS-IVS患儿男9例、女6例，手术时年龄（3.6±0.5）日龄，均于全身麻醉下成功实施顺行静动脉环路PBPV。术后即刻跨肺动脉瓣压差为（35±6）mmHg（1 mm Hg=0.133 kPa），右心室收缩压由（96±16）mmHg降至（59±14）mmHg（t=6.70，P<0.001），SpO2（吸入氧浓度0.48）由术前0.86±0.07升至术后0.97±0.03（t=4.81，P<0.001）；术后1个月所有患儿SpO2（未吸氧）均已恢复正常，与术前相比差异有统计学意义（t=0.16，P<0.001）。术后即刻8例患儿出现轻中度舒张期肺动脉瓣反流，未出现重度肺动脉瓣反流；术前6例三尖瓣重度反流术后均减轻为轻中度。术后3个月，1例患儿因跨肺动脉瓣压差升高至74 mmHg，再次行PBPV，术后即刻跨肺动脉瓣压差降至27 mmHg，恢复良好。15例患儿术后规律随访，三尖瓣瓣环Z值明显改善，由术前-1.9±0.8升至末次随访时-0.4±0.1（t=6.88，P<0.001）；末次随访残留肺动脉瓣轻中度反流3例，三尖瓣轻度反流2例，无中度及以上反流。 结论： 经顺行静动脉环路干预治疗新生儿CPS-IVS安全有效。.