Boudjemline Younes, Agnoletti Gabriella, Bonnet Damien, Sidi Daniel, Bonhoeffer Philipp
Service de Cardiologie Pédiatrique, Hôpital Necker Enfants Malades, 149 rue de Sevres, 75015 Paris cedex, France.
J Am Coll Cardiol. 2004 Mar 17;43(6):1082-7. doi: 10.1016/j.jacc.2003.10.037.
We report our initial experience with percutaneous pulmonary valve replacement in animals with large pulmonary trunks, using a modified percutaneous approach.
Percutaneous pulmonary valve replacement has recently been introduced, and early clinical experience has been reported. This technique is presently limited to patients with a right ventricular outflow tract no bigger than 22 mm in diameter.
In seven animals (groups 1 and 3), we implanted a newly designed nitinol stent in the shape of a conduit with a central restriction of its diameter, containing an 18-mm bovine valve, as a one-step procedure. The animals in groups 1 and 3 were sacrificed after valve implantation and after two-month follow-up, respectively. In the second group (n = 3), we expected to percutaneously reduce the diameter of the pulmonary artery. Eight weeks later, we implanted an 18-mm valve mounted in a balloon-expandable stent. These animals were sacrificed after valve implantation.
Eight of 10 devices were successfully delivered and were functioning perfectly at the initial evaluation and after two months. We failed to cross the tricuspid valve in two cases. The downsize mechanism allowed the pulmonary diameter to be reduced from 30 to 18 mm, without an impact on right ventricular function in any of the animals.
Non-surgical implantation of a pulmonary valve is possible in ewes with all types of pulmonary trunk, regardless of its size. A "downsize" stent is needed to allow valve implantation in a large trunk. Further refinements will make this technique feasible in humans.
我们报告了使用改良经皮方法对具有大肺动脉干的动物进行经皮肺动脉瓣置换的初步经验。
经皮肺动脉瓣置换术最近已被引入，并已有早期临床经验报道。该技术目前仅限于右心室流出道直径不超过22毫米的患者。
在7只动物（第1组和第3组）中，我们采用一步法植入了一种新设计的镍钛诺支架，其形状为带有中心直径限制的导管，内有一个18毫米的牛心包瓣膜。第1组和第3组的动物分别在瓣膜植入后和两个月随访后处死。在第二组（n = 3）中，我们期望经皮缩小肺动脉直径。8周后，我们植入了一个安装在球囊可扩张支架内的18毫米瓣膜。这些动物在瓣膜植入后处死。
10个装置中有8个成功输送，在初始评估时和两个月后功能良好。有2例未能穿过三尖瓣。缩小尺寸机制使肺动脉直径从30毫米减小到18毫米，且对任何动物的右心室功能均无影响。
对于所有类型肺动脉干的母羊，无论其大小，非手术植入肺动脉瓣都是可行的。需要一个“缩小尺寸”的支架以便在大的肺动脉干中植入瓣膜。进一步改进将使该技术在人类中可行。
