Reinhardt Zdenka, De Giovanni Joseph, Stickley John, Bhole Vinay K, Anderson Benjamin, Murtuza Bari, Mehta Chetan, Miller Paul, Dhillon Rami, Stumper Oliver
Department of Cardiology, Heart Unit, Birmingham Children's Hospital, NHS Foundation Trust, Birmingham, United Kingdom.
Cardiol Young. 2014 Apr;24(2):212-9. doi: 10.1017/S1047951113000024. Epub 2013 Feb 8.
To analyse the current practice and contribution of catheter interventions in the staged management of patients with hypoplastic left heart syndrome.
This study is a retrospective case note review of 527 patients undergoing staged Norwood/Fontan palliation at a single centre between 1993 and 2010. Indications and type of catheter interventions were reviewed over a median follow-up period of 7.5 years.
A staged Norwood/Fontan palliation for hypoplastic left heart syndrome was performed in 527 patients. The 30-day survival rate after individual stages was 76.5% at Stage I, 96.3% at Stage II, and 99.4% at Stage III. A total of 348 interventions were performed in 189 out of 527 patients. Freedom from catheter intervention in survivors was 58.2% before Stage II and 46.7% before Stage III. Kaplan-Meier freedom from intervention post Fontan completion was 55% at 10.8 years of follow-up. Post-stage I interventions were mostly directed to relieve aortic arch obstruction--84 balloon angioplasties--and augment pulmonary blood flow--15 right ventricle-to-pulmonary conduit interventions; post-Stage II interventions centred on augmenting size of the left pulmonary artery--73 procedures and abolishing systemic venous collaterals--32 procedures. After Stage III, the focus was on manipulating the size of the fenestration--42 interventions--and the left pulmonary artery -31 procedures.
Interventional cardiac catheterisation constitutes an integral part in the staged palliative management of patients with hypoplastic left heart syndrome. Over one-third (37%) of patients undergoing staged palliation required catheter intervention over the follow-up period.
分析导管介入治疗在左心发育不全综合征患者分期治疗中的当前应用情况及作用。
本研究是一项回顾性病例记录回顾，对1993年至2010年间在单一中心接受分期诺伍德/方坦姑息手术的527例患者进行分析。在中位随访期7.5年期间，对导管介入治疗的适应证和类型进行了回顾。
对527例左心发育不全综合征患者进行了分期诺伍德/方坦姑息手术。各阶段术后30天生存率分别为：I期76.5%，II期96.3%，III期99.4%。527例患者中有189例共进行了348次介入治疗。幸存者在II期前无需导管介入治疗的比例为58.2%，在III期前为46.7%。在随访10.8年时，方坦手术完成后采用Kaplan-Meier法计算的无介入治疗生存率为55%。I期术后介入治疗主要用于缓解主动脉弓梗阻（84次球囊血管成形术）和增加肺血流量（15次右心室至肺动脉导管介入）；II期术后介入治疗主要集中在扩大左肺动脉大小（73次手术）和消除体静脉侧支（32次手术）。III期术后，重点在于调整开窗大小（42次介入）和左肺动脉（31次手术）。
介入性心导管检查是左心发育不全综合征患者分期姑息治疗的重要组成部分。在接受分期姑息治疗的患者中，超过三分之一（37%）在随访期间需要导管介入治疗。
