Sivakumar Kothandam, Bhagyavathy Anpon, Coelho Robert, Satish Radhakrishnan, Krishnan Prasad
Department of Pediatric Cardiology, MIOT Hospital, Chennai, India.
Congenit Heart Dis. 2012 Nov-Dec;7(6):526-33. doi: 10.1111/j.1747-0803.2012.00657.x. Epub 2012 Apr 30.
Ductal stent (DS) in duct-dependent pulmonary circulation is less morbid than neonatal Blalock-Taussig shunt. However, there is concern if DS provides an adequately long palliation before definitive repair.
This is a retrospective review of clinical follow-up of all consecutive infants after successful DS performed by a single operator. They were divided into three anatomic groups. Group A neonates had balloon valvotomy for critical pulmonary stenosis or pulmonary atresia with intact ventricular septum, who needed DS patency until the right ventricle was adequate to provide antegrade pulmonary flows. Group B patients with tetralogy of Fallot and pulmonary atresia suited for later biventricular repair needed ductal patency until conduit surgery was completed. Group C patients with functionally univentricular hearts needed DS patency until bidirectional Glenn shunt completion.
Among 22 infants, four Group A patients followed for 26-54 months after balloon pulmonary valvotomy had adequate oxygen saturation and needed only short-term DS patency. In six out of nine Group B patients, corrective biventricular repair using conduits was performed after 5-14 months at a body weight of 5-7.5 kg. Bidirectional Glenn shunt and confluence repair were performed in seven of nine Group C patients weighing 6-8.5 kg after 8-15 months. The hilar pulmonary artery growth in B and C groups was adequate for surgical repair. No patient needed stent redilatations or additional shunts on follow-up for hypoxia. Four patients had sudden death.
The short-term patency of DS was adequate after balloon valvotomy for critical pulmonary stenosis or pulmonary atresia with intact ventricular septum. Duration of palliation by DS was also sufficient in univentricular hearts to allow adequate somatic growth before Glenn surgery. In patients with biventricular anatomy treated by DS, conduit repair had to be performed at a relatively early age. Interstage mortality was 18%.
在依赖导管的肺循环中，导管支架（DS）的发病率低于新生儿布莱洛克 - 陶西格分流术。然而，人们担心DS在进行最终修复之前是否能提供足够长的姑息治疗时间。
这是一项对由单一操作者成功实施DS的所有连续婴儿进行临床随访的回顾性研究。他们被分为三个解剖学组。A组新生儿因严重肺动脉狭窄或室间隔完整的肺动脉闭锁接受球囊瓣膜切开术，在右心室足以提供顺行肺血流之前需要DS保持通畅。B组法洛四联症和肺动脉闭锁且适合后期双心室修复的患者，在完成管道手术之前需要导管保持通畅。C组功能性单心室心脏患者在完成双向格林分流术之前需要DS保持通畅。
在22例婴儿中，4例A组患者在球囊肺动脉瓣膜切开术后随访26 - 54个月，氧饱和度充足，仅需要短期DS通畅。9例B组患者中有6例在体重5 - 7.5 kg时5 - 14个月后使用管道进行了双心室矫正修复。9例C组患者中有7例在体重6 - 8.5 kg时8 - 15个月后进行了双向格林分流术和汇合修复。B组和C组肺门肺动脉生长足以进行手术修复。随访期间没有患者因缺氧需要支架再扩张或额外分流。4例患者猝死。
对于严重肺动脉狭窄或室间隔完整的肺动脉闭锁患者，球囊瓣膜切开术后DS短期通畅是足够的。DS在单心室心脏中的姑息治疗持续时间也足以在格林手术前实现足够的身体生长。在接受DS治疗的双心室解剖结构患者中，必须在相对较早的年龄进行管道修复。过渡期死亡率为18%。
