Department of Paediatric Cardiology, A.O.R.N. 'Ospedali dei Colli', 2nd University of Naples, Naples, Italy.
Heart. 2016 Mar;102(6):459-64. doi: 10.1136/heartjnl-2015-308493. Epub 2016 Feb 1.
Significant and balanced pulmonary artery (PA) growth following arterial duct (AD) stenting has already been reported in literature. However, no data are so far available about the role of this percutaneous approach in promoting PA growth in the case of congenital heart disease (CHD) with completely duct-dependent pulmonary blood flow (CDD-PBF). Aim of this study was to evaluate the effect of AD stenting in this pathophysiological setting.
PA growth was evaluated as Nakata index and McGoon ratio as well as individual PA z-score changes in 49 patients submitted to neonatal AD stenting according to their pathophysiology (CDD-PBF (n=15) versus multiple PBF sources (n=34)).
Control angiography was performed 7.2±6.4 months (range 1-8, median 6) after AD stenting. In the whole population, significant and balanced PA growth was recorded (Nakata index+122±117%; left pulmonary artery (LPA) z-score +84±52%; right pulmonary artery (RPA) z-score +92±53% versus preprocedure, p<0.0001 for all comparisons). Percentage increase of global and branch vessel size was not significantly different in patients with CDD-PBF compared with those with multiple PBF sources (Nakata index 89±90% vs 144±124%; LPA z-score 63±40% vs 89±58%; RPA z-score 74±35% vs 100±57%, p=NS for all comparisons) as was final absolute PA size (Nakata index 237±90 vs 289±80 mm(2)/m(2), p=NS).
Percutaneous AD stenting was associated with significant and balanced PA growth in CHD with completely duct-dependent pulmonary circulation over a short-term follow-up. Thus, it may be considered as an alternative to surgical palliation in this subset of patients.
动脉导管（AD）支架置入后肺动脉（PA）显著且均衡的生长已经在文献中报道。然而，目前尚无关于这种经皮方法在完全依赖导管的肺血流（CDD-PBF）先天性心脏病（CHD）中促进 PA 生长的作用的数据。本研究旨在评估 AD 支架置入在这种病理生理环境下的效果。
根据患者的病理生理情况（CDD-PBF（n=15）与多种血流来源（n=34）），评估 49 例接受新生儿 AD 支架置入的患者的 PA 生长情况，如 Nakata 指数和 McGoon 比值以及个体 PA z 分数变化。
AD 支架置入后 7.2±6.4 个月（范围 1-8，中位数 6）进行对照血管造影。在整个人群中，记录到显著且均衡的 PA 生长（Nakata 指数增加 122±117％；左肺动脉（LPA）z 分数增加 84±52％；右肺动脉（RPA）z 分数增加 92±53％，与术前相比，所有比较均 p<0.0001）。与多血流来源患者相比，CDD-PBF 患者的整体和分支血管大小的增加百分比无显著差异（Nakata 指数增加 89±90％与 144±124％；LPA z 分数增加 63±40％与 89±58％；RPA z 分数增加 74±35％与 100±57％，所有比较 p=NS），最终的绝对 PA 大小也无差异（Nakata 指数 237±90 与 289±80 mm²/m²，p=NS）。
在短期随访中，CHD 完全依赖导管循环的患者经皮 AD 支架置入后，PA 显著且均衡生长。因此，在这部分患者中，它可以作为手术姑息治疗的替代方法。
