Ashwath Ravi, Gruenstein Daniel, Siwik Ernest
Pediatric Cardiology, RB&C, Case Western Reserve University, 11000 Euclid Avenue, Cleveland, OH 44145, USA.
Pediatr Cardiol. 2008 May;29(3):562-7. doi: 10.1007/s00246-007-9141-8. Epub 2007 Nov 29.
The objectives of this study were to evaluate the safety, efficacy, and outcomes of palliative percutaneous stent placement in infants with congenital heart disease (CHD). There is interest in improving outcomes of infants with CHD through interventional/surgical collaboration. Small, high-risk patients may benefit from delayed open operations, and endovascular stents may provide a means to defer surgery to more advantageous times in select infants. Patients weighing < or =10 kg in whom stent placement was attempted during 2003-2006 were identified. Diagnoses, indications, angiographic and hemodynamic data, complications, and outcomes were reviewed. Seventeen stents were successfully placed in 15 patients. The mean age was 10.21 months; the mean weight was 6.08 kg. Indications were branch pulmonary artery stenosis, coarctation, total anomalous pulmonary venous return with obstructed venous egress, right ventricle-pulmonary artery conduit, and shunt stenosis. Premounted Palmaz Genesis and Driver Mx stents were used. Average vessel diameter increased from 3.65 to 6.72 mm (p < 0.001). The pressure gradient fell from 24 to 15 mm Hg (p < 0.01). Two stents migrated. One was recaptured and implanted at the target site and one implanted away from the target site. None needed surgical intervention. Mean follow-up was 270 days. Five patients have had additional surgery; seven patients underwent 10 additional stent dilations. There was no procedural-related mortality. Five patients (33%) died during the follow-up period, none attributable to the stent placement. We conclude that stent placement can be successfully accomplished in select, small, high-risk patients. A collaborative interventional/surgical paradigm is important to ensure that the risk-benefit ratio is properly evaluated during the patient selection.
本研究的目的是评估姑息性经皮支架置入术在先天性心脏病（CHD）婴儿中的安全性、有效性和治疗结果。人们希望通过介入/外科协作改善CHD婴儿的治疗结果。小型、高危患者可能受益于延迟的开放性手术，血管内支架可能为某些婴儿将手术推迟到更有利的时机提供一种手段。确定了2003年至2006年期间尝试进行支架置入术的体重≤10 kg的患者。回顾了诊断、适应症、血管造影和血流动力学数据、并发症及治疗结果。15例患者成功置入了17个支架。平均年龄为10.21个月；平均体重为6.08 kg。适应症包括分支肺动脉狭窄、主动脉缩窄、完全性肺静脉异位引流伴静脉流出道梗阻、右心室-肺动脉管道及分流狭窄。使用了预装的Palmaz Genesis和Driver Mx支架。平均血管直径从3.65 mm增加到6.72 mm（p<0.001）。压力梯度从24 mmHg降至15 mmHg（p<0.01）。两个支架发生移位。一个被重新捕获并植入目标部位，另一个植入到了远离目标部位的地方。均无需手术干预。平均随访时间为270天。5例患者接受了额外的手术；7例患者接受了10次额外的支架扩张术。无手术相关死亡病例。5例患者（33%）在随访期间死亡，均与支架置入无关。我们得出结论，在选定的小型、高危患者中，支架置入术可以成功完成。介入/外科协作模式对于确保在患者选择过程中正确评估风险效益比很重要。
