Klinik für Kinderkardiologie und angeboren Herzfehler, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, München, Germany.
Eur Heart J. 2011 May;32(10):1260-5. doi: 10.1093/eurheartj/ehq520. Epub 2011 Jan 27.
Dysfunction of valved conduits in the right ventricular outflow tract (RVOT) limits durability and enforces repeated surgical interventions. We report on our combined two-centre experience with percutaneous pulmonary valve implantation (PPVI).
One hundred and two patients with RVOT dysfunction [median weight: 63 kg (54.2-75.9 kg), median age: 21.5 years (16.2-30.1 years), diagnoses: TOF/PA 61, TAC 14, TGA 9, other 10, AoS post-Ross-OP 8] were scheduled for PPVI since December 2006. Percutaneous pulmonary valve implantation was performed in all patients. Pre-stenting of the RVOT was done in 97 patients (95%). The median peak systolic RVOT gradient decreased from 37 mmHg (29-46 mmHg) to 14 mmHg (9-17 mmHg, P < 0.001) and the ratio RV pressure/AoP decreased from 62% (53-76%) to 36% (30-42%, P < 0.0001). The median end-diastolic RV-volume index (MRI) decreased from 106 mL/m(2) (93-133 mL/m(2)) to 90 mL/m(2) (71-108 mL/m(2), P = 0.001). Pulmonary regurgitation was significantly reduced in all patients. One patient died due to compression of the left coronary artery. The incidence of stent fractures was 5 of 102 (5%). During follow-up [median: 352 days (99-390 days)] one percutaneous valve had to be removed surgically 6 months after implantation due to bacterial endocarditis. In 8 of 102 patients, a repeated dilatation of the valve was done due to a significant residual systolic pressure gradient, which resulted in a valve-in-valve procedure in four.
This study shows that PPVI is feasible and it improves the haemodynamics in a selected patient collective. Apart from one coronary compression, the rate of complications at short-term follow-up was low. Percutaneous pulmonary valve implantation can be performed by experienced interventionalists with similar results as originally published. The intervention is technically challenging and longer clinical follow-up is needed.
右心室流出道（RVOT）中瓣膜导管的功能障碍限制了耐久性并需要反复进行手术干预。我们报告了我们在两个中心联合进行的经皮肺动脉瓣植入术（PPVI）的经验。
自 2006 年 12 月以来，102 例 RVOT 功能障碍患者[中位数体重：63 公斤（54.2-75.9 公斤），中位数年龄：21.5 岁（16.2-30.1 岁），诊断：TOF/PA61 例，TAC14 例，TGA9 例，其他 10 例，AoS 后 Ross-OP8 例]被计划接受 PPVI。所有患者均进行了经皮肺动脉瓣植入术。97 例患者（95%）行 RVOT 支架预扩张。RVOT 的收缩期峰值压力梯度从 37mmHg（29-46mmHg）降至 14mmHg（9-17mmHg，P<0.001），RV 压力/AoP 比值从 62%（53-76%）降至 36%（30-42%，P<0.0001）。中位舒张末期 RV 容积指数（MRI）从 106mL/m2（93-133mL/m2）降至 90mL/m2（71-108mL/m2，P=0.001）。所有患者的肺动脉瓣反流均显著减少。1 例患者因左冠状动脉受压而死亡。支架骨折的发生率为 5/102（5%）。在随访期间[中位数：352 天（99-390 天）]，1 例患者在植入后 6 个月因细菌性心内膜炎而需手术取出。在 102 例患者中，8 例因明显残留收缩期压力梯度而再次行瓣膜扩张，其中 4 例行瓣膜内瓣手术。
本研究表明，PPVI 是可行的，它可以改善选定患者群体的血液动力学。除 1 例冠状动脉受压外，短期随访的并发症发生率较低。经验丰富的介入专家可以进行经皮肺动脉瓣植入术，其结果与最初的研究结果相似。该介入操作具有技术挑战性，需要更长的临床随访。
