经皮肺动脉瓣植入术在年轻患者中的 2 年随访结果。
Percutaneous pulmonary valve implantation in the young 2-year follow-up.
机构信息
Department of Pediatrics, The Hospital for Sick Children, The Labatt Family Heart Centre, University of Toronto School of Medicine, Toronto, Canada.
出版信息
JACC Cardiovasc Interv. 2010 Apr;3(4):439-48. doi: 10.1016/j.jcin.2010.02.003.
OBJECTIVES
The aim of this study was to investigate physiological and clinical consequences of percutaneous pulmonary valve implantation (PPVI) in patients with chronic right ventricular outflow tract (RVOT) obstruction and volume overload.
BACKGROUND
The PPVI is a nonsurgical technique to address RVOT conduit dysfunction.
METHODS
Twenty-eight adolescents (median age 14.9 years; age range 10.9 to 19 years) underwent PPVI due to RVOT stenosis and/or pulmonary regurgitation (PR). Before and after PPVI echocardiographic and magnetic resonance imaging, cardiopulmonary exercise tests were obtained.
RESULTS
The RVOT gradient (p < 0.001) and right ventricular (RV) systolic pressure decreased (p < 0.001), acutely. Magnetic resonance imaging (median 6 months) documented reduction in RV end-diastolic (149 +/- 49 ml/m(2) vs. 114 +/- 35 ml/m(2), p < 0.005) volume, increases in left ventricular (LV) end-diastolic (p < 0.007) volume and cardiac output (RV: p < 0.04 and LV: p < 0.02), and reduced PR fraction (24 +/- 10% to 7 +/- 7%, p < 0.0001). Symptoms, aerobic exercise performance (maximal oxygen consumption: p < 0.0001) and ventilatory response to carbon dioxide production (p < 0.003) improved. After 24 months, echocardiography demonstrated the RV/systemic-pressure ratio, and RVOT peak pressure gradient reductions persisted, and PR was absent in 93% (n = 12 of 13) of the cohort. Freedom from surgery was 91%, 83%, and 83%, and freedom from transcatheter reintervention was 91%, 80%, and 80%, at 12, 24, and 36 months, respectively. There were no acute device-related complications, with stent fractures noted in 10.8%.
CONCLUSIONS
Percutaneous pulmonary valve implantation is feasible and safe in the young with dysfunctional RVOT conduits. An improvement in symptoms, hemodynamic status, and objective findings of exercise performance occurs. Early follow-up demonstrates persistent improvement in ventricular parameters, PR, and objective exercise capacity.
目的
本研究旨在探讨经皮肺动脉瓣植入术（PPVI）治疗慢性右心室流出道（RVOT）梗阻伴容量超负荷患者的生理和临床后果。
背景
PPVI 是一种非手术技术，用于解决 RVOT 导管功能障碍。
方法
28 名青少年（中位年龄 14.9 岁；年龄范围 10.9 至 19 岁）因 RVOT 狭窄和/或肺动脉瓣反流（PR）接受 PPVI。在 PPVI 前后，进行超声心动图和磁共振成像、心肺运动试验。
结果
RVOT 梯度（p < 0.001）和右心室（RV）收缩压（p < 0.001）在急性时下降。磁共振成像（中位时间 6 个月）记录到 RV 舒张末期容积（149 +/- 49 ml/m2 至 114 +/- 35 ml/m2，p < 0.005）减少，左心室（LV）舒张末期容积（p < 0.007）和心输出量增加（RV：p < 0.04 和 LV：p < 0.02），以及 PR 分数减少（24 +/- 10%至 7 +/- 7%，p < 0.0001）。症状、有氧运动表现（最大耗氧量：p < 0.0001）和二氧化碳产生的通气反应（p < 0.003）得到改善。24 个月后，超声心动图显示 RV/系统压力比和 RVOT 峰值压力梯度降低，93%（n = 12/13）的队列中 PR 消失。12、24 和 36 个月时，手术无复发率分别为 91%、83%和 83%，经导管再介入无复发率分别为 91%、80%和 80%。无急性器械相关并发症，10.8%的患者出现支架骨折。
结论
在患有功能性 RVOT 导管的年轻患者中，经皮肺动脉瓣植入术是可行和安全的。症状、血流动力学状态和运动表现的客观发现得到改善。早期随访显示心室参数、PR 和客观运动能力持续改善。
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