Stümper O, Gewillig M, Vettukattil J, Budts W, Chessa M, Chaudhari M, Wright J G C
The Heart Unit, Birmingham Children's Hospital, Birmingham, UK.
Heart. 2003 Oct;89(10):1227-30. doi: 10.1136/heart.89.10.1227.
To develop a modified technique for stenting the atrial septum in the treatment of patients with a failing Fontan operation or pulmonary hypertension.
Two tertiary referral centres.
Prospective collaborative clinical study.
A stent was mounted on a standard valvoplasty balloon catheter which was constricted to a predefined diameter by a loop created from a temporary pacing wire. Full balloon inflation created a diabolo shaped stent configuration. The technique was employed in 12 consecutive patients to relieve symptoms of a failing Fontan circulation (n = 6) or severe pulmonary hypertension (n = 6).
Ex vivo studies confirmed that a diabolo shaped stent configuration could be achieved using the above technique. Transcatheter stent implantation was successful in all 12 patients. All six Fontan patients showed significant clinical improvement. Right atrial pressure decreased from (mean (SD)) 16.8 (2.5) to 13.7 (1.9) mm Hg (p < 0.05), and arterial oxygen saturation from 92.8 (1.8)% to 82.7 (3.8)% (p < 0.01). Six patients underwent successful stent fenestration for treatment of pulmonary hypertension. All stents were patent and stable at the most recent follow up (mean 1.75 (1.05) years). No early or late stent related complications were encountered.
This new technique allows placement of a diabolo shaped stent with a predefined diameter across the atrial septum. The diabolo shape increases stent stability, facilitates recrossing of the stent during future catheter interventions, and ensures medium term stent patency.
开发一种改良技术，用于在法洛四联症手术失败或患有肺动脉高压的患者治疗中对房间隔进行支架置入。
两个三级转诊中心。
前瞻性协作临床研究。
将支架安装在标准瓣膜成形球囊导管上，通过临时起搏导丝形成的环将其收缩至预定直径。完全球囊膨胀可形成双锥形支架构型。该技术应用于12例连续患者，以缓解法洛四联症循环衰竭（n = 6）或严重肺动脉高压（n = 6）的症状。
体外研究证实，使用上述技术可实现双锥形支架构型。12例患者经导管支架植入均成功。所有6例法洛四联症患者临床症状均有显著改善。右心房压力从（均值（标准差））16.8（2.5）mmHg降至13.7（1.9）mmHg（p < 0.05），动脉血氧饱和度从92.8（1.8）%降至82.7（3.8）%（p < 0.01）。6例患者成功进行了支架开窗术以治疗肺动脉高压。在最近一次随访（平均1.75（1.05）年）时，所有支架均通畅且稳定。未遇到早期或晚期与支架相关的并发症。
这项新技术允许在房间隔上放置具有预定直径的双锥形支架。双锥形形状增加了支架稳定性，便于在未来导管干预期间重新穿过支架，并确保支架中期通畅。
