Department of Pediatric Cardiology, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Eur J Cardiothorac Surg. 2012 Jul;42(1):57-60. doi: 10.1093/ejcts/ezr258. Epub 2012 Jan 26.
Implantation of stents into the ductus arteriosus is an alternative treatment to palliative or corrective cardiac surgery in newborns with duct-dependent pulmonary circulation, although the use of this technique for congenital heart disease is limited.
Between April 2010 and June 2011, 13 patients underwent patent ductus arteriosus stenting after full assessment by echocardiogram and angiogram, two of patients had pulmonary atresia (PA) and ventricular septal defect (VSD), six patients had PA with intact ventricular septum (IVS), four patients had critical pulmonary stenosis with IVS and one single ventricle physiology with PA and four patients had radiofrequency-assisted perforation of the pulmonary valve at the same time. All procedures were retrograde through the femoral artery, except one, which was by the femoral vein approach.
The mean age and weight during intervention were 10.5±5.7 days and 3.1±0.4 kg, respectively. The mean of procedure and scopy time, time of stay in intensive care, total out-of-hospital and total follow-up time were 138.88±67.11 min; 40.32±25.86 min; 4.88±6.07 days; 11.00±6.89 days and 86.40±73.21 days, respectively. The mean of the radiation amount was 1054.27±1106.91 cGy/cm2. The mean of saturation before and after intervention were 64.44±5.83; 81.88±6.95%, respectively. Procedure-related deaths were observed in two patients. The causes of death were pulmonary haemorrhage (n=1) and retroperitoneal haemorrhage (n=1). Two patients also died after discharge before surgery due to sepsis (n=1) and aspiration pneumonia (n=1). Eight of 13 patients achieved stent patency during 6 months of follow up and re-stenosis developed in one patient (1/8; 12.5%) who had undergone a Glenn operation at 4.5 months of age.
Ductal stenting is a practicable, effective, safer and less invasive method compared palliative or corrective surgery. Patients with ductal stenting have growth of the pulmonary artery which provides additional time for surgical repair. Our data suggested that ductal stenting should be considered as a first treatment step in newborns with duct-depended pulmonary circulation. However, long-term palliation without stent re-stenosismight still be a concern especially in patients with hypoplastic pulmonary arteries.
在依赖动脉导管循环的新生儿中，对于姑息性或矫正性心脏手术，将支架植入动脉导管是一种替代治疗方法，尽管该技术在先天性心脏病中的应用受到限制。
2010 年 4 月至 2011 年 6 月，13 名患者在超声心动图和血管造影充分评估后接受了未闭动脉导管支架植入术，其中 2 名患者患有肺动脉瓣闭锁（PA）和室间隔缺损（VSD），6 名患者患有未闭动脉导管伴完整室间隔（IVS），4 名患者患有严重的肺动脉瓣狭窄伴 IVS 和 1 名单心室生理学伴 PA，同时有 4 名患者进行了射频辅助的肺动脉瓣穿孔。所有手术均经股动脉逆行进行，只有 1 例经股静脉入路进行。
介入治疗时的平均年龄和体重分别为 10.5±5.7 天和 3.1±0.4kg。手术和镜检时间、重症监护室停留时间、总住院时间和总随访时间分别为 138.88±67.11 分钟、40.32±25.86 分钟、4.88±6.07 天、11.00±6.89 天和 86.40±73.21 天。平均辐射量为 1054.27±1106.91cGy/cm2。介入治疗前后的平均饱和度分别为 64.44±5.83%和 81.88±6.95%。两名患者发生与治疗相关的死亡。死亡原因分别为肺出血（n=1）和腹膜后出血（n=1）。两名患者在手术后出院前因败血症（n=1）和吸入性肺炎（n=1）死亡。13 名患者中有 8 名在 6 个月的随访中实现了支架通畅，其中 1 名患者（1/8；12.5%）在 4.5 个月龄时接受了 Glenn 手术，出现再狭窄。
与姑息性或矫正性手术相比，动脉导管支架置入术是一种可行、有效、更安全、创伤更小的方法。接受动脉导管支架置入术的患者肺动脉生长，这为手术修复提供了额外的时间。我们的数据表明，在依赖动脉导管循环的新生儿中，动脉导管支架置入术应被视为首选治疗方法。然而，特别是对于肺动脉发育不良的患者，长期姑息性治疗而不发生支架再狭窄仍然是一个问题。
