Mallula Kiran, Vaughn Gabrielle, El-Said Howaida, Lamberti John J, Moore John W
Division of Cardiology, Rady Children's Hospital, University of California San Diego School of Medicine, San Diego, California.
Division of Cardiovascular Surgery, Rady Children's Hospital, University of California San Diego School of Medicine, San Diego, California.
Catheter Cardiovasc Interv. 2015 Jun;85(7):1196-202. doi: 10.1002/ccd.25870. Epub 2015 Feb 23.
We sought to compare ductal stenting (DS) to systemic-pulmonary artery shunt (SPS) in a contemporary cohort of patients having pulmonary atresia with intact ventricular septum (PAIVS).
Alternative palliative strategies (interventional versus surgical) are currently available for initial palliation of ductal dependent patients with various forms of congenital heart disease. There is little data available to guide strategy selection.
A retrospective review of patients with PAIVS at our institution from Jan 2006 to Dec 2013 was performed. Demographic, echocardiographic, procedural, and follow-up data were reviewed and analyzed.
Twenty-nine patients were identified. Thirteen underwent DS and 16 underwent SPS. In the DS group, 6 had radiofrequency perforation of the pulmonary valve, and 12 underwent balloon pulmonary valvuloplasty (BPV) prior to DS. SPS was performed after perforation of the pulmonary valve in 1 patient and after BPV in 4 patients. Procedural success was 92.8% in the DS group versus 93.3% in the SPS group. In the DS group, one patient required emergency shunting due to intra-procedural ductal spasm. In the SPS group there was one procedure related death, and there were six significant procedure-related complications. Five patients required re-interventions prior to hospital discharge. The median length of hospital stay for the DS versus SPS group was 10 versus 23 days, respectively (P < 0.05). Post discharge, there were seven reinterventions in the DS group and two reinterventions in the SPS group.
DS may provide a safe and effective alternative to SPS in selected patients with PAIVS.
我们试图在当代一组室间隔完整的肺动脉闭锁（PAIVS）患者中比较导管支架置入术（DS）与体肺分流术（SPS）。
目前有多种替代姑息治疗策略（介入治疗与手术治疗）可用于各种形式先天性心脏病的导管依赖型患者的初始姑息治疗。几乎没有可用数据来指导策略选择。
对2006年1月至2013年12月在我们机构就诊的PAIVS患者进行回顾性研究。对人口统计学、超声心动图、手术及随访数据进行回顾和分析。
共纳入29例患者。13例行DS，16例行SPS。在DS组中，6例患者进行了肺动脉瓣射频穿孔，12例在DS术前进行了球囊肺动脉瓣成形术（BPV）。1例患者在肺动脉瓣穿孔后行SPS，4例在BPV后行SPS。DS组手术成功率为92.8%，SPS组为93.3%。在DS组，1例患者因术中导管痉挛需要紧急分流。在SPS组，有1例手术相关死亡，6例严重手术相关并发症。5例患者在出院前需要再次干预。DS组与SPS组的中位住院时间分别为10天和23天（P < 0.05）。出院后，DS组有7例再次干预，SPS组有2例再次干预。
对于部分PAIVS患者，DS可能是一种安全有效的替代SPS的方法。
