Bökenkamp Regina, Blom Nico A, De Wolf Daniel, Francois Kristine, Ottenkamp Jaap, Hazekamp Mark G
Department of Pediatric Cardiology and Thoracic Surgery, Leiden University Medical Center, Center of Congenital Anomalies of the Heart Amsterdam/Leiden, Leiden, The Netherlands.
Eur J Cardiothorac Surg. 2005 Apr;27(4):544-7. doi: 10.1016/j.ejcts.2005.01.013.
The surgical treatment of pulmonary artery stenoses in small children with complex cardiac lesions can be technically difficult. A hybrid-approach combining corrective surgery and intraoperative stent placement may be complementary in these patients.
Descriptive study in 11 small children (age: one week to 12 years, median of 12 months, weight: 2.5-20 kg) after previous cardiac surgery. Intraoperative stenting of pulmonary arteries was performed involving paediatric cardiologist and cardiac surgeon. Stenting was combined with repair of pulmonary atresia (n=2), right ventricular outflow and pulmonary artery reconstruction (n=3), unifocalisation of pulmonary arteries (n=1), revision of distal anastomosis of RV-PA-conduit after truncus repair (n=1), revision of distal anastomosis of RV-PA-conduit after AVSD/Fallot repair (n=1), aortic arch patch reconstruction after anatomical correction for transposition of the great arteries (n=1), bidirectional cavopulmonary anastomosis after Norwood I operation for hypoplastic left heart syndrome, (n=1) retrieval of a dislodged stent from the left pulmonary artery (n=1). In seven patients stenting was planned electively while in four patients it took place on an emergency base.
No complications occurred during stent implantation. One patient died three weeks postoperatively from diffuse bleeding due to a coagulation disorder. Ten patients left hospital after the surgical intervention with concomitant stent implantation. Stent re-dilatation was necessary in 4 patients 2-24 months postoperatively. After a median follow-up of 15 months ranging from 3 weeks to 7.5 years all stents were patent as diagnosed by angiography in 6 patients and by colour-Doppler in all other patients. One year after stent placement one stent was removed and another surgically opened during re-operation for conduit replacement in the smallest patient from this series. There was one late death during operative right ventricular outflow-tract reconstruction after initial stent placement.
With intraoperative stent placement surgically difficult patch augmentation of small and fragile pulmonary vessels during repair of complex cardiac lesions can be avoided. Stents recruit pulmonary vessels and keep them open and amenable to future percutaneous or surgical interventions.
对患有复杂心脏病变的小儿进行肺动脉狭窄的外科治疗在技术上可能具有挑战性。一种将矫正手术与术中支架置入相结合的混合方法可能对这些患者具有补充作用。
对11例曾接受心脏手术的小儿（年龄：1周龄至12岁，中位数为12个月，体重：2.5 - 20千克）进行描述性研究。术中肺动脉支架置入由儿科心脏病专家和心脏外科医生共同完成。支架置入与以下手术联合进行：肺动脉闭锁修复术（n = 2）、右心室流出道及肺动脉重建术（n = 3）、肺动脉单源化术（n = 1）、动脉干修复术后右心室 - 肺动脉管道远端吻合口修复术（n = 1）、房间隔缺损/法洛四联症修复术后右心室 - 肺动脉管道远端吻合口修复术（n = 1）、大动脉转位解剖矫正术后主动脉弓补片重建术（n = 1）、左心发育不全综合征诺伍德I期手术后双向腔肺吻合术（n = 1）、从左肺动脉取出移位支架（n = 1）。7例患者的支架置入为择期手术，4例为急诊手术。
支架置入过程中未发生并发症。1例患者术后3周因凝血障碍导致弥漫性出血死亡。10例患者在接受手术干预并同时置入支架后出院。4例患者在术后2 - 24个月需要进行支架再扩张。中位随访时间为15个月（范围为3周至7.5年），6例患者经血管造影诊断所有支架通畅，其他患者经彩色多普勒检查均显示支架通畅。支架置入1年后，在该系列中最小的患者进行管道置换再次手术时，取出了1个支架，另1个支架进行了手术开放处理。在最初置入支架后进行右心室流出道重建手术时有1例晚期死亡。
通过术中置入支架，可避免在复杂心脏病变修复过程中对细小脆弱的肺血管进行外科难度较大的补片扩大术。支架可使肺血管扩张并保持开放状态，便于未来进行经皮或外科干预。
