Troost Els, Delcroix Marion, Gewillig Marc, Van Deyk Kristien, Budts Werner
Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
Catheter Cardiovasc Interv. 2009 Feb 1;73(2):173-9. doi: 10.1002/ccd.21760.
A significant number of patients with pulmonary hypertension are resistant to medical therapy. We wanted to evaluate whether the modified technique of stent fenestration of the interatrial septum would be feasible and safe, and offer clinical benefit.
The medical records of all patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension who underwent a stent fenestration of the interatrial septum between 2001 and 2008 were reviewed. In all fifteen patients (12 female, mean age 48.2 +/- 20.5 years) a successful fenestration procedure could be performed. Median follow-up time between diagnosis and fenestration was 2.3 years (range from 0.5 to 18.6 years). Mean event free survival since diagnosis and after septostomy was 9.8 +/- 2.9 and 3.2 +/- 0.8 years, respectively. When one extreme outlier was excluded, the 6 min walk distance improved significantly from 309 +/- 69 m immediately before fenestration to 374 +/- 84 m, 3-4 months after fenestration (n = 8, paired t-test, P = 0.03). No stent occlusion occurred.
The modified stent fenestration technique is feasible and safe in patients with severe pulmonary hypertension. In a selected group of patients, functional capacity might improve although disease progression continues.
相当一部分肺动脉高压患者对药物治疗耐药。我们想评估房间隔支架开窗改良技术是否可行、安全并能带来临床益处。
回顾了2001年至2008年间所有接受房间隔支架开窗术的肺动脉高压和慢性血栓栓塞性肺动脉高压患者的病历。在所有15例患者（12例女性，平均年龄48.2±20.5岁）中，均成功实施了开窗手术。诊断至开窗的中位随访时间为2.3年（范围0.5至18.6年）。自诊断起及房间隔造口术后的平均无事件生存期分别为9.8±2.9年和3.2±0.8年。排除一个极端异常值后，6分钟步行距离从开窗前即刻的309±69米显著改善至开窗后3至4个月的374±84米（n = 8，配对t检验，P = 0.03）。未发生支架闭塞。
改良的支架开窗技术在重度肺动脉高压患者中可行且安全。在部分选定患者中，尽管疾病仍在进展，但功能能力可能会改善。
