Patil Nilkanth C, Saxena Anita, Gupta Saurabh K, Juneja Rajnish, Mishra Sundeep, Ramakrishnan Sivasubramanian, Kothari Shyam S
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India.
Catheter Cardiovasc Interv. 2016 Nov;88(5):E145-E150. doi: 10.1002/ccd.25760. Epub 2014 Dec 15.
To review the success and technical aspects of pulmonary valve (PV) perforation using chronic total occlusion (CTO) hardware in patients with pulmonary atresia and intact ventricular septum (PA-IVS).
Interventional therapy is possible in selected patients with PA-IVS. Among the various interventional options available, radiofrequency and laser assisted perforation may be more successful, but require expertise and may be substantially costly.
We describe the technique of mechanical catheter PV perforation using currently available coronary hardware meant for coronary CTO in nine cases with PA-IVS. After complete echocardiographic evaluation and informed parental consent was obtained, patients were electively intubated, mechanically ventilated, adequately heparinized and were placed on intravenous prostaglandin infusion. Basic steps involved were-localizing the atretic segment and accomplishing coaxial alignment of catheters using biplane fluoroscopy, crossing the atretic segment with the soft end of perforating guidewire, stabilizing the assembly and performing graded balloon dilatation with the balloon size never exceeding 130% of pulmonary annulus diameter. For crossing the atretic PV, a retrograde approach was used in one patient where the antegrade approach was not possible.
The procedure was successful in 8/9 cases (89%). Valve opening was achieved in all eight patients with immediate fall in right ventricular (RV) systolic pressures. One neonate died following surgery after catheter induced RV perforation. All surviving cases were discharged from the hospital in good general condition with no evidence of heart failure and a room air oxygen saturation of >85%. No patient required an additional pulmonary irrigation procedure.
With appropriate patient and hardware selection, PV perforation using readily available coronary hardware is feasible in PA-IVS. © 2014 Wiley Periodicals, Inc.
回顾在肺动脉闭锁合并完整室间隔（PA-IVS）患者中使用慢性完全闭塞（CTO）器械进行肺动脉瓣（PV）穿孔的成功率及技术要点。
部分PA-IVS患者可进行介入治疗。在现有的各种介入方法中，射频和激光辅助穿孔可能更有效，但需要专业技术且成本高昂。
我们描述了使用现有的用于冠状动脉CTO的器械对9例PA-IVS患者进行机械导管PV穿孔的技术。在完成超声心动图全面评估并获得患儿家长知情同意后，患者接受择期插管、机械通气，充分肝素化，并静脉输注前列腺素。基本步骤包括：确定闭锁段位置，使用双平面荧光透视实现导管同轴对齐，用穿孔导丝的软头穿过闭锁段，固定组件，并使用直径不超过肺动脉瓣环直径130%的球囊进行分级球囊扩张。对于1例无法采用顺行途径穿过闭锁PV的患者，采用了逆行途径。
该手术在8/9例（89%）患者中成功。所有8例患者均实现瓣膜开放，右心室（RV）收缩压即刻下降。1例新生儿在导管导致RV穿孔后术后死亡。所有存活病例出院时一般情况良好，无心力衰竭迹象，室内空气下氧饱和度>85%。无患者需要额外的肺灌注手术。
通过适当选择患者和器械，使用现有的冠状动脉器械进行PV穿孔在PA-IVS中是可行的。© 2014威利期刊公司
