Locker Chaim, Dearani Joseph A, O'Leary Patrick W, Puga Francisco J
Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Ann Thorac Surg. 2008 Aug;86(2):588-94;discussion 594-5. doi: 10.1016/j.athoracsur.2008.04.041.
Occasionally pulmonary artery banding is necessary to reduce pulmonary arterial blood flow and pressure in patients who cannot be repaired in a single stage. Traditional extraluminal PAB can be associated with significant morbidity. We describe our technique, applications, and results of endoluminal pulmonary artery banding (EPAB) with and without creation of an aortopulmonary window (APW) for complex cardiac anomalies.
Thirty-two patients underwent EPAB; 20 patients had simultaneous creation of an APW. Median patient age was 40 days (range, 2 to 3,210); median weight was 3.5 kg (range, 2.4 to 23 kg). Endoluminal pulmonary artery banding fenestrations of 2 to 8 mm were centrally placed in a Dacron patch that was attached circumferentially and intraluminally in the main pulmonary artery. Fenestrations were sized by presence of APW and patient weight. Thirty-one of 32 patients underwent associated cardiac procedures. The mean follow-up period was 2.6 years (range, 0 to 15.5).
Overall early mortality was 31% (10 of 32); 8% in EPAB alone (1 of 12) and 45% for EPAB+APW (9 of 20). Of the early deaths, 7 of 10 had severe, preoperative ventricular dysfunction. There was 1 early EPAB-related complication requiring band revision for relief of partial obstruction of the APW. At hospital dismissal, the mean pressure gradient after EPAB was 55.1 +/- 8.4 mm Hg as assessed by echocardiography. No patient experienced distal pulmonary hypertension, distortion, or band occlusion. There were 6 late deaths. At late follow-up, 5 patients underwent band revision, and complete repair was accomplished in 10 patients.
Endoluminal pulmonary artery banding provided a consistently effective and durable reduction in pulmonary arterial blood flow with no pulmonary artery distortion. Early mortality was low for EPAB alone. Endoluminal pulmonary artery banding alone is preferred when controlled pulmonary blood flow and cardiopulmonary bypass are required to address intracardiac abnormalities. The role of EPAB with APW needs to be defined.
对于无法一期修复的患者，偶尔需要进行肺动脉环扎术以减少肺动脉血流和压力。传统的腔外肺动脉环扎术可能会导致显著的发病率。我们描述了我们采用和不采用建立主肺动脉窗（APW）的腔内肺动脉环扎术（EPAB）治疗复杂心脏畸形的技术、应用及结果。
32例患者接受了EPAB；20例患者同时建立了APW。患者年龄中位数为40天（范围2至3210天）；体重中位数为3.5千克（范围2.4至23千克）。2至8毫米的腔内肺动脉环扎开窗位于涤纶补片中央，涤纶补片沿主肺动脉腔内周向附着。根据是否存在APW及患者体重确定开窗大小。32例患者中有31例接受了相关心脏手术。平均随访期为2.6年（范围0至15.5年）。
总体早期死亡率为31%（32例中的10例）；单纯EPAB为8%（12例中的1例），EPAB + APW为45%（20例中的9例）。早期死亡病例中，10例中有7例术前存在严重心室功能障碍。有1例早期EPAB相关并发症，需要对环扎带进行修正以缓解APW的部分梗阻。出院时，经超声心动图评估，EPAB后平均压力阶差为55.1±8.4毫米汞柱。无患者出现远端肺动脉高压、扭曲或环扎带阻塞。有6例晚期死亡。在晚期随访中，5例患者进行了环扎带修正，10例患者完成了完全修复。
腔内肺动脉环扎术能持续有效地减少肺动脉血流，且不会导致肺动脉扭曲。单纯EPAB的早期死亡率较低。当需要控制肺血流和体外循环以处理心内异常时，首选单纯腔内肺动脉环扎术。EPAB联合APW的作用有待确定。
