Khambadkone Sachin, Coats Louise, Taylor Andrew, Boudjemline Younes, Derrick Graham, Tsang Victor, Cooper Jeffrey, Muthurangu Vivek, Hegde Sanjeet R, Razavi Reza S, Pellerin Denis, Deanfield John, Bonhoeffer Philipp
Great Ormond Street Hospital, London WC1N 3JH, UK.
Circulation. 2005 Aug 23;112(8):1189-97. doi: 10.1161/CIRCULATIONAHA.104.523266. Epub 2005 Aug 15.
Right ventricular outflow tract (RVOT) reconstruction with valved conduits in infancy and childhood leads to reintervention for pulmonary regurgitation and stenosis in later life.
Patients with pulmonary regurgitation with or without stenosis after repair of congenital heart disease had percutaneous pulmonary valve implantation (PPVI). Mortality, hemodynamic improvement, freedom from explantation, and subjective and objective changes in exercise tolerance were end points. PPVI was performed successfully in 58 patients, 32 male, with a median age of 16 years and median weight of 56 kg. The majority had a variant of tetralogy of Fallot (n=36), or transposition of the great arteries, ventricular septal defect with pulmonary stenosis (n=8). The right ventricular (RV) pressure (64.4+/-17.2 to 50.4+/-14 mm Hg, P<0.001), RVOT gradient (33+/-24.6 to 19.5+/-15.3, P<0.001), and pulmonary regurgitation (PR) (grade 2 of greater before, none greater than grade 2 after, P<0.001) decreased significantly after PPVI. MRI showed significant reduction in PR fraction (21+/-13% versus 3+/-4%, P<0.001) and in RV end-diastolic volume (EDV) (94+/-28 versus 82+/-24 mL.beat(-1).m(-2), P<0.001) and a significant increase in left ventricular EDV (64+/-12 versus 71+/-13 mL.beat(-1).m(-2), P=0.005) and effective RV stroke volume (37+/-7 versus 42+/-9 mL.beat(-1).m(-2), P=0.006) in 28 patients (age 19+/-8 years). A further 16 subjects, on metabolic exercise testing, showed significant improvement in VO2max (26+/-7 versus 29+/-6 mL.kg(-1).min(-1), P<0.001). There was no mortality.
PPVI is feasible at low risk, with quantifiable improvement in MRI-defined ventricular parameters and pulmonary regurgitation, and results in subjective and objective improvement in exercise capacity.
在婴幼儿和儿童期使用带瓣管道进行右心室流出道（RVOT）重建会导致在以后的生活中因肺动脉反流和狭窄而需要再次干预。
先天性心脏病修复术后出现肺动脉反流（伴或不伴狭窄）的患者接受了经皮肺动脉瓣植入术（PPVI）。终点指标为死亡率、血流动力学改善情况、免于瓣膜取出情况以及运动耐量的主观和客观变化。58例患者（32例男性）成功接受了PPVI，中位年龄16岁，中位体重56千克。大多数患者患有法洛四联症变体（n = 36）或大动脉转位、室间隔缺损合并肺动脉狭窄（n = 8）。PPVI术后右心室（RV）压力（从64.4±17.2降至50.4±14毫米汞柱，P<0.001）、RVOT梯度（从33±24.6降至19.5±15.3，P<0.001）和肺动脉反流（PR）（术前2级及以上，术后无大于2级，P<0.001）均显著降低。MRI显示PR分数（21±13%对3±4%，P<0.001）、RV舒张末期容积（EDV）（94±28对82±24毫升·次-1·米-2，P<0.001）显著降低，左心室EDV（64±12对71±13毫升·次-1·米-2，P = 0.005）和有效RV每搏输出量（37±7对42±9毫升·次-1·米-2，P = 0.006）在28例患者（年龄19±8岁）中显著增加。另外16例受试者在代谢运动测试中显示最大摄氧量有显著改善（26±7对29±6毫升·千克-1·分钟-1，P<0.001）。无死亡病例。
PPVI风险低且可行，MRI定义的心室参数和肺动脉反流有可量化的改善，并使运动能力在主观和客观上得到改善。
