Department of Congenital Heart Disease, Evelina Children's Hospital, London, United Kingdom.
J Am Coll Cardiol. 2012 Apr 17;59(16):1468-76. doi: 10.1016/j.jacc.2012.01.022.
This study investigated the outcome for all patients undergoing catheter valve perforation for pulmonary atresia with intact ventricular septum (PAIVS) 21 years after the first procedure at their center.
Catheter perforation for PAIVS is now an established procedure. However, the management of the borderline right ventricle (RV) is controversial, and there may be a place for novel techniques such as stenting of the arterial duct.
There were 37 successful valve perforations (total 39 patients). Median length of follow-up was 9.2 years (range 2.2 to 21.0 years). Seventeen patients had stenting of the arterial duct. The mean (SD) initial z-score for the tricuspid valve was -5.1 (±3.4), and a further 142 sets of measurements were taken to assess the growth of the RV of survivors.
There were 8 deaths (21%), and no deaths after the first 35 days. There were no late arrhythmias or ischemic events. Twenty-five patients (83% of survivors) have a biventricular circulation. For patients who had stenting of the arterial duct, significant reductions in early reintervention (0 vs. 7 patients, p = 0.009) and hospital stay (17.4 ± 18.1 days vs. 33.8 ± 28.6 days, p = 0.012) occurred, with no increase in mortality or morbidity. There was no catch-up growth of the RV in patients who had a biventricular outcome (z-score increase +0.08/year, p = 0.26).
Long-term survival is good, and even small RVs may be amenable to this procedure. Multiple interventions may be required to achieve biventricular circulation, but stenting of the arterial duct may reduce hospital stay and repeat procedures.
本研究调查了中心首例肺动脉瓣穿孔术（PAIVS）后 21 年所有接受经导管肺动脉瓣穿孔术治疗的完整室间隔型肺动脉闭锁（PAIVS）患者的结局。
经导管肺动脉瓣穿孔术治疗 PAIVS 现已成为一种既定的术式。然而，对于临界右心室（RV）的处理方式仍存在争议，可能需要采用诸如动脉导管支架置入等新技术。
共成功实施 37 例（共 39 例患者）瓣膜穿孔术。中位随访时间为 9.2 年（范围 2.2 至 21.0 年）。17 例患者接受了动脉导管支架置入术。初始三尖瓣 z 值平均值（标准差）为-5.1（±3.4），进一步对存活患者的 RV 生长情况进行了 142 次测量。
共有 8 例患者（21%）死亡，且前 35 天内无死亡。无晚期心律失常或缺血性事件。25 例患者（存活患者的 83%）具有双心室循环。对于接受动脉导管支架置入术的患者，早期再干预（0 例与 7 例，p = 0.009）和住院时间（17.4 ± 18.1 天与 33.8 ± 28.6 天，p = 0.012）显著减少，死亡率或发病率没有增加。具有双心室结局的患者的 RV 无追赶性生长（RV 增加 z 值为+0.08/年，p = 0.26）。
长期存活率良好，即使是较小的 RV 也可能适合该手术。可能需要多次干预才能实现双心室循环，但动脉导管支架置入术可能会减少住院时间和重复手术。
