Barik Ramachandra
Associate Professor, Department of Cardiology, Nizam's Institute of Medical Sciences, Hyderabad 500082, India.
Indian Heart J. 2016 Jan-Feb;68(1):99-101. doi: 10.1016/j.ihj.2015.06.038. Epub 2016 Jan 18.
Since 1988, TCC of PMIVSD became an alternative treatment for anatomically suitable patients with high risk of surgical closure. TCC is less invasive but the optimal timing and technique have not developed much in the last four decades. The dismal prognosis at the contemporary sight should not be discouraged. The rapid innovation in TAVI is an example. The learning curve slopes down to the line of inertia in inaction. Some innovations have slept for centuries but their potential needs to be celebrated. The published experience of TCC of PMIVSD across the globe is limited as they are based on consensus. The experience related to clinical practice has heterogeneous topography around the globe because of the morbid pathology. The increasing number of onsite cardiothoracic wings, better imaging tools, LVADS, and ECMO, along with improvement in well matching hardware to the pathology of PMIVSD, build incremental confidence. The improved outcomes believes in the enthusiasm of closing the PMIVSD using either surgical or TCC approach and is recommended.
自1988年以来,经导管封堵膜周部室间隔缺损(PMIVSD)成为解剖结构合适但手术封堵风险高的患者的一种替代治疗方法。经导管封堵术侵入性较小,但在过去四十年中,最佳时机和技术并没有太大发展。从当代的角度来看,其预后不佳不应令人气馁。经导管主动脉瓣置入术(TAVI)的快速创新就是一个例子。学习曲线向下倾斜至无为的惯性线。有些创新沉睡了几个世纪,但它们的潜力值得发掘。全球范围内已发表的PMIVSD经导管封堵术经验有限,因为这些经验基于共识。由于病态病理,全球范围内与临床实践相关的经验分布不均。现场心胸外科科室数量的增加、更好的成像工具、左心室辅助装置(LVADS)和体外膜肺氧合(ECMO),以及与PMIVSD病理更匹配的硬件的改进,增强了信心。改善的结果得益于使用手术或经导管封堵方法闭合PMIVSD的热情,值得推荐。