Department of Cardiovascular Surgery, Albert Ludwigs University of Freiburg, Freiburg, Germany.
Eur J Cardiothorac Surg. 2011 Sep;40(3):552-6. doi: 10.1016/j.ejcts.2010.11.041. Epub 2011 Feb 17.
Dilatation of RV outflow after surgical patch repair represents a problem for seating a percutaneous valve. We present the data of a new catheter-based, self-expanding tissue valve with a diameter up to 31 mm.
7 Patients (median 9 years, range 2 to 24 years) with severe PR due to RV outflow tract dilatation after patch repair or percutaneous procedures were treated with a catheter-based, self-expanding porcine pulmonary valve (Biointegral®). Valve diameter ranged between 15 and 29 mm. Maximum follow-up was 40 months. Patients were postoperatively assessed on day 1 and 6 months after the procedure, including physical examination, 12 lead electrocardiography and cross-sectional echocardiography with color Doppler.
Valve implantation was successful in all patients. Implantation was performed using three different routes: RVOT after partial sternotomy, pulmonary artery after mini-thoracotomy, or via the RV apex. Median follow-up was 25 months (5-40) identifying no significant morbidity and no death. Echocardiography revealed competent valves, no paravalvular leaks, no valve migration and no significant gradient in the RVOT.
The new, self-expanding, catheter-based pulmonary valve is easy to implant via an antegrade (RVOT, RV) or retrograde approach (PA) even in dilated RV outflow tracts. The procedure can be done without CPB under echocardiographic guidance.
外科补丁修复后 RV 流出道扩张代表了经皮瓣膜植入的问题。我们提出了一种新的基于导管的、自扩张组织瓣膜的相关数据，其直径可达 31 毫米。
7 名患者（中位数 9 岁，范围 2 至 24 岁）因 RV 流出道扩张后补丁修复或经皮治疗后严重 PR 接受基于导管的、自扩张猪肺动脉瓣（Biointegral®）治疗。瓣膜直径在 15 至 29 毫米之间。最大随访时间为 40 个月。术后第 1 天和 6 个月对患者进行评估，包括体格检查、12 导联心电图和彩色多普勒超声心动图。
所有患者均成功植入瓣膜。使用三种不同途径植入瓣膜：部分胸骨切开术后 RVOT、小开胸术后肺动脉或经 RV 心尖。中位随访时间为 25 个月（5-40），无明显发病率和死亡率。超声心动图显示瓣膜功能良好，无瓣周漏、瓣膜移位和 RVOT 无明显梯度。
新型、自扩张、基于导管的肺动脉瓣可通过顺行（RVOT、RV）或逆行途径（PA）植入，即使在 RV 流出道扩张的情况下也很容易植入。在超声心动图引导下，无需体外循环即可进行该操作。
