Dori Yoav, Sathanandam Shyam, Glatz Andrew C, Gillespie Matthew J, Rome Jonathan J
Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Pennsylvania.
Catheter Cardiovasc Interv. 2014 Jul 1;84(1):86-93. doi: 10.1002/ccd.25326. Epub 2014 Jan 7.
The goal of this report is to describe a percutaneous approach to rerouting hepatic venous return in patients who developed progressive cyanosis due to unilateral pulmonary arteriovenous malformations (PAVM) after the total cavopulmonary connection (TCPC) operation.
Unilateral PAVM can develop in patients after TCPC operation when there is unequal distribution of hepatic venous return between the two lungs. This often results in progressive cyanosis and the need for surgical re-intervention. A percutaneous based approach for rerouting hepatic venous return has never been described.
We retrospectively reviewed the clinical data on four patients who underwent percutaneous rerouting procedures. One patient with a misaligned TCPC underwent realignment of the circuit with a bare metal stent. In three patients a combination of bare metal and covered stents were needed to achieve the desired results.
The rerouting procedures were successful in all patients with significant improvement in oxygen saturation from a median of 75% (range 55-80%) to a median of 90% (range 84-92%) (P = 0.02). There were no recorded short term or intermediate term complications with maximum follow-up time of 43 months.
Percutaneous rerouting of hepatic venous flow is feasible and should be considered when a surgical approach is not possible; this strategy may serve as a viable alternative to complex operative approaches in select cases. Furthermore studies are needed to determine the long-term efficacy of this procedure.
本报告的目的是描述一种经皮方法，用于在全腔静脉肺动脉连接（TCPC）手术后因单侧肺动静脉畸形（PAVM）而出现进行性发绀的患者中重新引导肝静脉回流。
在TCPC手术后，如果两肺之间肝静脉回流分布不均，患者可能会发生单侧PAVM。这通常会导致进行性发绀，并需要进行手术再次干预。从未描述过基于经皮的肝静脉回流重新引导方法。
我们回顾性分析了4例接受经皮重新引导手术患者的临床资料。1例TCPC排列不齐的患者使用裸金属支架对循环系统进行了重新排列。在3例患者中，需要联合使用裸金属支架和覆膜支架才能达到预期效果。
所有患者的重新引导手术均成功，氧饱和度从中位数75%（范围55 - 80%）显著提高到中位数90%（范围84 - 92%）（P = 0.02）。在最长43个月的随访期内，未记录到短期或中期并发症。
经皮肝静脉血流重新引导是可行的，在无法采用手术方法时应予以考虑；在某些情况下，该策略可作为复杂手术方法的可行替代方案。此外，还需要进一步研究以确定该手术的长期疗效。
