Mollet Alix, Stos Bertrand, Bonnet Damien, Sidi Daniel, Boudjemline Younes
Pediatric Cardiology, Assistance Publique des Hôpitaux de Paris, Necker For Sick Children, 149, rue de Sèvres, 75015 Paris cedex, France.
Eur Heart J. 2006 Dec;27(24):3065-72. doi: 10.1093/eurheartj/ehl354. Epub 2006 Oct 31.
Pulmonary artery banding (PAB) is the first palliation in infants with complex congenital heart disease and elevated pulmonary blood flow. In older patients with corrected transposition of the great arteries, it may be used to re-train the left ventricle. To date, the only option is surgical. We report the development and the evaluation of a device for transcatheter PAB.
We intended to implant a pulmonary artery (PA) reducer percutaneously between the native pulmonic valve and the pulmonary bifurcation. Immediately following its insertion, we planned to implant a balloon expandable stent inside the restriction to calibrate the banding. Sheep were sacrificed acutely (group 1, n=6) and after 1 month of follow-up (group 2, n=6), the reducer was implanted successfully in all animals. It allowed the PA diameter to be reduced from 25 to 10.5 mm. Bare stents were successfully delivered inside the reducer. No paraprosthetic leak was found by injecting contrast dye. After the insertion procedure, signs of intolerance to obstruction were present in all animals and prompted us to dilate the stents from 12 to 16 mm. One animal from group 1 died before a balloon dilatation could be achieved. In the animals from group 2, the mean systolic gradient was 19 and 34.8 mmHg, respectively, at early and late evaluation.
Implantation of a PA reducer is possible in sheep, through a transcatheter approach allowing intravascular PAB. Miniaturization of the device is necessary to enlarge its use from adulthood to childhood.
肺动脉环缩术（PAB）是患有复杂先天性心脏病且肺血流量增加的婴儿的首次姑息治疗方法。在矫正型大动脉转位的老年患者中，它可用于重新训练左心室。迄今为止，唯一的选择是手术。我们报告了一种经导管肺动脉环缩装置的研发和评估情况。
我们打算经皮在天然肺动脉瓣和肺动脉分叉之间植入一个肺动脉（PA）缩窄器。插入后，我们计划在缩窄处植入一个球囊可扩张支架来校准环缩。对绵羊进行急性处死（第1组，n = 6）以及在随访1个月后处死（第2组，n = 6），缩窄器在所有动物中均成功植入。它使肺动脉直径从25毫米减小至10.5毫米。裸支架成功输送至缩窄器内。注入造影剂后未发现人工瓣膜旁漏。插入操作后，所有动物均出现对梗阻不耐受的体征，促使我们将支架从12毫米扩张至16毫米。第1组中有1只动物在球囊扩张完成前死亡。在第2组动物中，早期和晚期评估时的平均收缩期压差分别为19和34.8毫米汞柱。
通过经导管方法在绵羊体内植入肺动脉缩窄器从而实现血管内肺动脉环缩术是可行的。为了将其应用范围从成人扩大到儿童，该装置的小型化是必要的。
