Department of Pediatric Cardiology, Ulsan of Unversity College of Medicine, Asan Medical Center, Seoul, Korea.
Korean Circ J. 2012 Jan;42(1):40-5. doi: 10.4070/kcj.2012.42.1.40. Epub 2012 Jan 31.
Pulmonary arterial stenosis is a relatively common complication after corrective operation of congenital heart disease. Unilateral stenosis of pulmonary arteries could result in decrease perfusion of affected lung, pulmonary regurgitation, or elevation of right ventricular pressure. Eventually there are increasing risks of right ventricular failure, arrhythmia, or sudden death. However we have limited data of pulmonary arterial stent in paediatric population as the treatment of branch pulmonary stenosis. This study aimed at validating the effectiveness and investigating complications of pulmonary arterial stent implantation in a single institution during mid-term follow up period.
A total of 42 patients (50 stents) were implanted for treating branch pulmonary arterial stenosis. We used cardiac catheterization for comparing diameter after stent implantation directly and lung perfusion scan indirectly. We also investigated any adverse effect relating the procedure.
Percent stenosis of stenotic lesions were decreased from 54.1±10.7% to 22.8±12.5% (p<0.001) and degree of decrement in affected lung perfusion was declined from 22.7±8.0% to 10.3±9.0% (p<0.001) immediately and lasts during mid-term follow up period. Complication rate relating the procedure was 12% (6 out of 12) and there was no mortality case.
This series showed immediate and short term effectiveness of pulmonary arterial stent in congenital heart defects. We concluded that percutaneous transcatheter implantation of pulmonary arterial stent was safe and effective during short and mid-term follow up period.
肺动脉瓣狭窄是先天性心脏病矫正手术后较为常见的并发症。肺动脉单侧狭窄可导致患侧肺灌注减少、肺动脉瓣反流或右心室压力升高。最终,右心衰竭、心律失常或猝死的风险增加。然而,由于儿童分支肺动脉狭窄的治疗方法有限,我们对肺动脉支架在儿科人群中的应用数据了解有限。本研究旨在验证单中心中期随访期间肺动脉支架植入术的有效性,并探讨其并发症。
共对 42 例(50 个支架)患者进行了分支肺动脉狭窄的支架植入治疗。我们使用心导管术直接比较支架植入后的直径,并通过肺灌注扫描间接比较。我们还调查了与该手术相关的任何不良影响。
狭窄病变的狭窄百分比从 54.1±10.7%降至 22.8±12.5%(p<0.001),受影响肺灌注的减少程度从 22.7±8.0%降至 10.3±9.0%(p<0.001),即刻起效,并在中期随访期间持续。与手术相关的并发症发生率为 12%(6 例),无死亡病例。
本系列研究表明,肺动脉支架在先天性心脏病中的即刻和短期疗效显著。我们的结论是,经皮导管植入肺动脉支架在短期和中期随访期间是安全有效的。