Sandrio Stany, Purbojo Ariawan, Arndt Florian, Toka Okan, Glöckler Martin, Dittrich Sven, Cesnjevar Robert, Rüffer André
Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
Department of Pediatric Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany.
Eur J Cardiothorac Surg. 2015 Sep;48(3):470-80. doi: 10.1093/ejcts/ezu464. Epub 2014 Dec 16.
This retrospective study evaluated the feasibility and related outcome of intraluminal pulmonary artery banding (I-PAB).
Thirty-two children underwent I-PAB between July 2006 and April 2014. The median age and weight were 60 days (range: 5 days to 4.2 years) and 3.7 kg (range: 2.6-13.0 kg), respectively. Cardiac diagnoses included single ventricle morphology (n = 11), complex ventricular septal defects (n = 11), balanced atrioventricular septal defects (n = 3), congenitally corrected transposition of the great arteries (n = 2) and aortic arch hypoplasia with ventricular septal defects (n = 5). On cardiopulmonary bypass (CPB), 2 I-PAB modifications with either 1 (n = 24) or 2 ('hour-glass-technique', n = 8) fenestrated pericardial patches were performed.
The median fenestration size was 5 mm (range: 4-6.5 mm). In 18 patients I-PAB was a solitary procedure; in 3 of them the decision was made intraoperatively. There was no hospital mortality. The median interval to debanding was 189 days (range: 112 days to 2.6 years). During this period, we observed a significant increase in the pressure gradient over I-PAB (P < 0.01), whereas arterial saturations remained stable. Four patients received balloon dilatation of I-PAB to prolong the palliation period. No patient experienced band occlusion, pulmonary hypertension related to I-PAB, coronary or pulmonary valve impairment. Debanding was performed in 27 patients and one of them required pulmonary patch arterioplasty due to I-PAB-associated pulmonary trunk distortion. Three patients are still awaiting further surgery. There were 2 late deaths prior to, and 3 after debanding, all not related to I-PAB.
I-PAB with an exactly defined internal orifice is feasible and effective. Although arterial saturations seem to remain stable, balloon dilatation of I-PAB can be performed safely and efficiently in order to prolong the palliation period. The rate of I-PAB-related complications is low, which might improve the long-term patient outcome. Therefore, despite requiring CPB, I-PAB is our institutional preference for children who require pulmonary artery banding.
本回顾性研究评估了腔内肺动脉环扎术（I-PAB）的可行性及相关结果。
2006年7月至2014年4月期间，32例儿童接受了I-PAB手术。年龄中位数和体重中位数分别为60天（范围：5天至4.2岁）和3.7千克（范围：2.6 - 13.0千克）。心脏诊断包括单心室形态（n = 11）、复杂室间隔缺损（n = 11）、平衡型房室间隔缺损（n = 3）、先天性矫正型大动脉转位（n = 2）以及合并室间隔缺损的主动脉弓发育不全（n = 5）。在体外循环（CPB）期间，采用两种I-PAB改良方法，分别使用1个（n = 24）或2个（“沙漏技术”，n = 8）带孔心包补片。
带孔大小中位数为5毫米（范围：4 - 6.5毫米）。18例患者I-PAB为单独手术，其中3例在术中做出该决定。无住院死亡病例。去环扎的中位间隔时间为189天（范围：112天至2.6年）。在此期间，我们观察到I-PAB上的压力梯度显著增加（P < 0.01），而动脉血氧饱和度保持稳定。4例患者接受了I-PAB球囊扩张以延长姑息治疗期。无患者出现环扎闭塞、与I-PAB相关的肺动脉高压、冠状动脉或肺动脉瓣损伤。27例患者进行了去环扎手术，其中1例因I-PAB相关的肺动脉干扭曲需要进行肺动脉补片血管成形术。3例患者仍在等待进一步手术。去环扎术前有2例晚期死亡，去环扎术后有3例晚期死亡，均与I-PAB无关。
具有精确界定内口的I-PAB是可行且有效的。尽管动脉血氧饱和度似乎保持稳定，但I-PAB球囊扩张可安全有效地进行，以延长姑息治疗期。I-PAB相关并发症发生率低，这可能改善患者的长期预后。因此，尽管需要CPB，但对于需要肺动脉环扎的儿童，I-PAB是我们机构的首选方法。
