Sreeram N, Emmel M, Ben-Mime L, Brockmeier K, Bennink G
Department of Paediatric Cardiology, University Hospital of Cologne, Cologne, Germany.
Clin Res Cardiol. 2008 Mar;97(3):181-6. doi: 10.1007/s00392-007-0614-9. Epub 2007 Nov 28.
There are few data on successful recanalization of acutely occluded modified aortopulmonary shunts in infants in whom the major component of pulmonary flow is shunt-dependent.
Seven infants (age range 6 days to 7 months) with modified (polytetrafluoroethylene) aortopulmonary shunts (central shunt n = 6, modified Blalock-Taussig shunt n = 1), in whom acute shunt occlusion was documented following surgery (interval from shunt surgery 2-6 days) underwent emergency cardiac catheterization with a view to reopening the shunt. Anterograde right ventricle to pulmonary artery flow was present in three patient; two other had additional aortopulmonary collateral vessels, and intravenous prostaglandin E (PGE1) infusion was restarted in three infants to achieve or maintain ductal patency. All occluded shunts could be crossed with a 4F endhole catheter and various guidewire combinations. Balloon dilation was performed using a balloon with the same nominal diameter as the shunt (5 or 6 mm).
All shunts were successfully recanalized. Two infants with recurrent cyanotic episodes underwent stent implantation in the right ventricular outflow tract (RVOT) during the same procedure. One infant required shunt revision 24 h following balloon angioplasty, during which a small clot was evacuated from the distal end of the shunt. An immediate improvement in oxygen saturation could be documented in all patients. In the remaining six infants, shunt patency was confirmed at follow-up, until further definitive repair. One infant died of non-cardiac causes, while awaiting definitive repair.
This small series demonstrates that acutely occluded shunts can be successfully recanalized, and that patency can be maintained until further definitive surgery in the majority of infants.
关于婴儿期急性闭塞的改良主肺动脉分流术成功再通的数据很少，这些婴儿的肺血流主要依赖分流。
7例婴儿（年龄范围6天至7个月），采用改良（聚四氟乙烯）主肺动脉分流术（中央分流6例，改良布莱洛克 - 陶西格分流1例），术后记录有急性分流闭塞（分流术后间隔2 - 6天），接受紧急心导管检查以重新开通分流。3例患者存在右心室至肺动脉的顺行血流；另外2例有额外的主肺动脉侧支血管，3例婴儿重新开始静脉输注前列腺素E（PGE1）以实现或维持动脉导管通畅。所有闭塞的分流均可通过4F端孔导管和各种导丝组合穿过。使用与分流器标称直径相同（5或6mm）的球囊进行球囊扩张。
所有分流均成功再通。2例反复出现紫绀发作的婴儿在同一手术过程中在右心室流出道（RVOT）植入了支架。1例婴儿在球囊血管成形术后24小时需要进行分流修正，在此期间从分流器远端清除了一个小血块。所有患者的氧饱和度均立即得到改善。其余6例婴儿在随访中分流保持通畅，直至进一步进行确定性修复。1例婴儿在等待确定性修复期间死于非心脏原因。
这个小系列研究表明，急性闭塞的分流可以成功再通，并且在大多数婴儿中可以维持通畅直至进一步进行确定性手术。
