Guo Ying, Yu Zhiqing, Liu Tingliang, Gao Wei, Huang Meirong, Li Fen, Fu Lijun, Zhao Pengjun
Department of Cardiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai.
Department of Cardiology, Shanghai Children's Medical Center Affiliated to School of Medicine, Shanghai Jiao Tong University, Shanghai. Email:
Zhonghua Er Ke Za Zhi. 2014 May;52(5):358-61.
Branch pulmonary artery stenosis is one of the common congenital heart disease. Stent implantation to relieve branch pulmonary artery stenosis (BPAS) is an alternative to failed surgical or balloon angioplasty. The aim of this study was to explore the indication, methods and complications of using balloon expandable stent placement to treat branch pulmonary artery stenosis, and evaluate the results of stent implantation in the treatment of branch pulmonary artery stenosis.
From August 2005 to December 2012, 19 patients underwent an attempt at stent implantation. The median age of those patients was 9.1 years (range 4.0-15.0 years). The median weight was 31.7 kg (range 17.0-60.5 kg); 14/19 patients underwent post surgical repair of tetralogy of Fallot, one patient received post surgical repair of pulmonary atresia with ventricular septal defect, one patient underwent post surgical repair of pulmonary atresia with intact septum, one with native left BPAS, and one was after surgical repair of aortopulmonary window and the other truncus arteriosus. CP stent and NuMED Balloon-in-Balloon catheter were selected according to digital subtracted angiography measurements. After checking for correct position by angiography, the inner balloon and outer balloon was inflated successively to expand the stent to desired diameter. Statistical analysis was performed with the unpaired Student t test.
A total of 26 stents were implanted successfully in 19 patients. The systolic gradient across the stenosis fell from a median of (36.0 ± 18.3) to (3.8 ± 3.4) mmHg (P < 0.01, 1 mmHg = 0.133 kPa) and the diameter of the narrowest segment improved from (6.0 ± 1.9) to (11.6 ± 3.1) mm (P < 0.01). The right ventricle to aortic pressure ratio fell from 0.68 to 0.49 (P < 0.01). Complications included the following: two stents were malpositioned in the right ventricular outflow tract and one balloon ruptured when dilated the hole of the stent. No other complications occurred. All patients were followed up for 6 months to 6.0 (2.5 ± 1.8) years. One patient underwent stent re-dilation in order to accommodate somatic growth two years later.
Balloon expandable stents are safe and effective in relieving BPAS. Stent implantation should be considered the treatment of choice for most patients with BPAS. Stents placed into growing children will require further dilation to keep up with normal somatic growth. Intermediate and long-term follow up studies have shown excellent results after further dilation over time.
分支肺动脉狭窄是常见的先天性心脏病之一。植入支架以缓解分支肺动脉狭窄（BPAS）是手术或球囊血管成形术失败后的一种替代方法。本研究的目的是探讨使用球囊扩张支架置入治疗分支肺动脉狭窄的适应证、方法及并发症，并评估支架植入治疗分支肺动脉狭窄的效果。
2005年8月至2012年12月，19例患者尝试进行支架植入。这些患者的中位年龄为9.1岁（范围4.0 - 15.0岁）。中位体重为31.7 kg（范围17.0 - 60.5 kg）；19例患者中14例接受过法洛四联症的外科修复，1例接受过室间隔缺损合并肺动脉闭锁的外科修复，1例接受过室间隔完整的肺动脉闭锁的外科修复，1例为原发性左分支肺动脉狭窄，1例为主动脉肺动脉窗外科修复术后，另1例为动脉干外科修复术后。根据数字减影血管造影测量结果选择CP支架和NuMED球囊内球囊导管。通过血管造影检查位置正确后，依次充盈内球囊和外球囊以将支架扩张至所需直径。采用成组t检验进行统计学分析。
19例患者共成功植入26枚支架。狭窄部位的收缩期压差从中位值（36.0±18.3）降至（3.8±3.4）mmHg（P<0.01，1 mmHg = 0.133 kPa），最窄处直径从（6.0±1.9）mm增至（11.6±3.1）mm（P<0.01）。右心室与主动脉压力比值从0.68降至0.49（P<0.01）。并发症包括：2枚支架在右心室流出道位置不当，1枚球囊在扩张支架孔时破裂。未发生其他并发症。所有患者随访6个月至6.0（2.5±1.8）年。1例患者在两年后为适应身体生长进行了支架再次扩张。
球囊扩张支架在缓解BPAS方面安全有效。对于大多数BPAS患者，支架植入应被视为首选治疗方法。植入儿童体内的支架需要进一步扩张以跟上正常身体生长。中长期随访研究表明，随着时间推移进一步扩张后效果良好。
