Malekzadeh-Milani Sophie, Ladouceur Magalie, Cohen Sarah, Iserin Laurence, Boudjemline Younes
Centre de référence malformations cardiaques congénitales complexes - M3C, Necker Hospital for Sick Children, Georges-Pompidou European Hospital, Assistance Publique des Hopitaux de Paris, Paediatric Cardiology, Paris, France.
Centre de référence malformations cardiaques congénitales complexes - M3C, Necker Hospital for Sick Children, Georges-Pompidou European Hospital, Assistance Publique des Hopitaux de Paris, Paediatric Cardiology, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75270 Paris cedex 06, France.
Arch Cardiovasc Dis. 2014 Nov;107(11):592-8. doi: 10.1016/j.acvd.2014.07.045. Epub 2014 Sep 11.
Although widely accepted worldwide, indications for percutaneous valve replacement are limited to treatment of dysfunction of prosthetic conduits inserted in the right ventricular outflow tract (RVOT). There has been little evaluation of the use of the Melody(®) valve for patched non-circular pulmonary pathways.
To evaluate the outcomes of Melody valve insertion in patients with a patched non-circular RVOT.
We analysed procedural and outcomes data from 34 patients who underwent Melody valve implantation for a non-circular RVOT. RVOT preparation was done in all patients, using different techniques (conventional, Russian doll and/or PA jailing). Melody valve insertion was performed concomitantly in most patients.
All procedures were successful. Sixteen patients had complex additional procedures, including the jailing technique (n=5), the Russian doll technique (n=6) and multiple stent implantations (Russian jailing; n=5). The remaining patients were treated using the conventional technique with systematic prestenting. Three early complications occurred: one haemoptysis; one residual RVOT obstruction needing recatheterization 48 hours after percutaneous pulmonary valve implantation; and one stent embolization during advancement of the Ensemble(®) delivery system. The mean follow-up period was 2.6 years postprocedure. There was no stent fracture, migration or embolization. Two patients developed a significant paraprosthetic leak and one received a second Melody valve.
Careful patient selection, balloon sizing and RVOT preparation with prestenting are required to create a safe landing zone for the Melody valve. Short-term follow-up shows excellent results with no stent fracture or migration and appears promising.
尽管经皮瓣膜置换术在全球范围内已被广泛接受，但其适应症仅限于治疗右心室流出道（RVOT）植入的人工管道功能障碍。对于使用美敦力（Melody®）瓣膜治疗修补后的非圆形肺动脉通路，目前评估较少。
评估在修补后的非圆形RVOT患者中植入美敦力瓣膜的效果。
我们分析了34例因非圆形RVOT接受美敦力瓣膜植入术患者的手术过程和结果数据。所有患者均采用不同技术（传统技术、俄罗斯套娃技术和/或肺动脉封堵技术）进行RVOT准备。大多数患者同时进行美敦力瓣膜植入。
所有手术均成功。16例患者进行了复杂的附加手术，包括封堵技术（n = 5）、俄罗斯套娃技术（n = 6）和多次支架植入（俄罗斯封堵；n = 5）。其余患者采用传统技术并进行系统性预扩张支架植入治疗。发生了3例早期并发症：1例咯血；1例经皮肺动脉瓣植入术后48小时出现残余RVOT梗阻，需要再次导管介入治疗；1例在Ensemble®输送系统推进过程中发生支架栓塞。术后平均随访期为2.6年。未发生支架断裂、移位或栓塞。2例患者出现明显的人工瓣膜旁漏，1例接受了第二个美敦力瓣膜。
需要仔细选择患者、进行球囊尺寸测量并通过预扩张支架植入进行RVOT准备，以为美敦力瓣膜创造安全的着陆区。短期随访显示效果极佳，无支架断裂或移位，前景乐观。
