裸金属支架置入术与经皮肺动脉瓣植入术治疗右心室流出道梗阻的比较：利用X射线/磁共振混合实验室进行急性生理学评估
Comparison of bare metal stenting and percutaneous pulmonary valve implantation for treatment of right ventricular outflow tract obstruction: use of an x-ray/magnetic resonance hybrid laboratory for acute physiological assessment.
作者信息
Lurz Philipp, Nordmeyer Johannes, Muthurangu Vivek, Khambadkone Sachin, Derrick Graham, Yates Robert, Sury Michael, Bonhoeffer Philipp, Taylor Andrew M
机构信息
UCL Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, Cardiorespiratory Unit, London, UK.
出版信息
Circulation. 2009 Jun 16;119(23):2995-3001. doi: 10.1161/CIRCULATIONAHA.108.836312. Epub 2009 Jun 1.
BACKGROUND
Treatment of right ventricular outflow tract obstruction is possible with a bare metal stent (BMS), although this treatment causes pulmonary regurgitation. In this study, we assessed the acute physiological effects of BMS versus percutaneous pulmonary valve implantation (PPVI) using an x-ray/magnetic resonance hybrid laboratory.
METHODS AND RESULTS
Fourteen consecutive children (median age, 12.9 years) with significant right ventricular outflow tract obstruction underwent BMS followed by PPVI. Magnetic resonance imaging (ventricular volumes and function and great vessel blood flow) and hemodynamic assessment (invasive pressure measurements) were performed before BMS, after BMS, and after PPVI; all were performed under general anesthesia in an x-ray/magnetic resonance hybrid laboratory. BMS significantly reduced the ratio of right ventricular to systemic pressure (0.75+/-0.17% versus 0.41+/-0.14%; P<0.001) with no further change after PPVI (0.42+/-0.11; P=1.0). However, BMS resulted in free pulmonary regurgitation (21.3+/-10.7% versus 41.4+/-7.5%; P<0.001), which was nearly abolished after PPVI (3.6+/-5.6%; P<0.001). Effective right ventricular stroke volume (right ventricular stroke volume minus pulmonary regurgitant volume) after BMS remained unchanged (33.8+/-7.3 versus 32.6+/-8.7 mL/m2; P=1.0) but was significantly increased after revalvulation with PPVI (41.0+/-8.0 mL/m2; P=0.004). These improvements after PPVI were accompanied by a significant heart rate reduction (75.5+/-17.7 bpm after BMS versus 69.0+/-16.9 bpm after PPVI; P=0.006) at maintained cardiac output (2.5+/-0.5 versus 2.4+/-0.5 versus 2.7+/-0.5 mL x min(-1) x m(-2); P=0.14).
CONCLUSIONS
Using an x-ray/magnetic resonance hybrid laboratory, we have demonstrated the superior acute hemodynamic effects of PPVI over BMS in patients with right ventricular outflow tract obstruction.
背景
尽管使用裸金属支架（BMS）治疗右心室流出道梗阻会导致肺动脉反流，但这种治疗方法是可行的。在本研究中，我们使用X射线/磁共振混合实验室评估了BMS与经皮肺动脉瓣植入术（PPVI）的急性生理效应。
方法与结果
连续14例患有严重右心室流出道梗阻的儿童（中位年龄12.9岁）先接受了BMS治疗，随后接受了PPVI治疗。在BMS治疗前、BMS治疗后以及PPVI治疗后进行了磁共振成像（心室容积与功能以及大血管血流）和血流动力学评估（有创压力测量）；所有检查均在X射线/磁共振混合实验室的全身麻醉下进行。BMS显著降低了右心室与体循环压力之比（从0.75±0.17降至0.41±0.14；P<0.001），PPVI治疗后无进一步变化（0.42±0.11；P=1.0）。然而，BMS导致了明显的肺动脉反流（从21.3±10.7增至41.4±7.5；P<0.001），PPVI治疗后几乎完全消除（3.6±5.6；P<0.001）。BMS治疗后的有效右心室每搏输出量（右心室每搏输出量减去肺动脉反流容积）保持不变（33.8±7.3与32.6±8.7 mL/m²；P=1.0），但在PPVI再次瓣膜置换后显著增加（41.0±8.0 mL/m²；P=0.004）。PPVI治疗后的这些改善伴随着心率显著降低（BMS治疗后为75.5±17.7次/分钟，PPVI治疗后为69.0±16.9次/分钟；P=0.006），同时心输出量维持不变（分别为2.5±0.5、2.4±0.5和2.7±0.5 mL·min⁻¹·m⁻²；P=0.14）。
结论
使用X射线/磁共振混合实验室，我们证明了在右心室流出道梗阻患者中，PPVI的急性血流动力学效应优于BMS。
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