在室间隔完整的肺动脉闭锁中使用慢性完全闭塞导丝进行经导管肺动脉瓣穿孔术。
Transcatheter pulmonary valve perforation using chronic total occlusion wire in pulmonary atresia with intact ventricular septum.
作者信息
Bakhru Shweta, Marathe Shilpa, Saxena Manish, Verma Sudeep, Saileela Rajan, Dash Tapan K, Koneti Nageswara Rao
机构信息
Department of Pediatric Cardiology, Care Hospital, The Institute of Medical Sciences, Hyderabad, Telangana, India.
Department of Pediatric Cardiac Surgery, Care Hospital, The Institute of Medical Sciences, Hyderabad, Telangana, India.
出版信息
Ann Pediatr Cardiol. 2017 Jan-Apr;10(1):5-10. doi: 10.4103/0974-2069.197065.
BACKGROUND
Perforation of pulmonary valve using radiofrequency ablation in pulmonary atresia with intact ventricular septum (PA IVS) is a treatment of choice. However, significant cost of the equipment limits its utility, especially in the developing economies.
OBJECTIVE
To assess the feasibility, safety, and efficacy of perforation of pulmonary valve using chronic total occlusion (CTO) wires in patients with PA IVS as an alternative to radiofrequency ablation.
METHODS
This is a single-center, nonrandomized, retrospective study conducted during June 2008 to September 2015. Twenty-four patients with PA IVS were selected for the procedure during the study period. The median age and weight of the study population were 8. days and 2.65 kg, respectively. Four patients were excluded after right ventricular angiogram as they showed right ventricular-dependent coronary circulation. The pulmonary valve perforation was attempted using various types of CTO wires based on the tip load with variable penetrating characteristics.
RESULTS
The procedure was successful in 16 of twenty patients using CTO wires: Shinobi in nine, Miracle in four, CROSS-IT in two, and Conquest Pro in one. Two patients had perforation of right ventricular outflow tract (RVOT). Pericardiocentesis was required in one patient to relieve cardiac tamponade. Later, the same patient underwent successful hybrid pulmonary valvotomy. The other patient underwent ductus arteriosus (DA) stenting. Balloon atrial septostomy was needed in three cases with systemic venous congestion. Desaturation was persistent in five cases necessitating DA or RVOT stenting to augment pulmonary blood flow. There were two early and two late deaths. The mean follow-up was 22.66 ± 16 months. Three patients underwent one and half ventricle repair and one Blalock-Taussig shunt during follow-up.
CONCLUSION
Perforation of the pulmonary valve can be done successfully using CTO wires in selected cases of pulmonary atresia with intact ventricular septum.
背景
在室间隔完整的肺动脉闭锁（PA IVS）中，使用射频消融术进行肺动脉瓣穿孔是一种首选治疗方法。然而，设备成本高昂限制了其应用，尤其是在发展中经济体。
目的
评估在PA IVS患者中使用慢性完全闭塞（CTO）导丝进行肺动脉瓣穿孔替代射频消融的可行性、安全性和有效性。
方法
这是一项于2008年6月至2015年9月期间进行的单中心、非随机、回顾性研究。研究期间选择了24例PA IVS患者进行该手术。研究人群的中位年龄和体重分别为8天和2.65千克。4例患者在右心室血管造影后因显示右心室依赖型冠状动脉循环而被排除。根据具有不同穿透特性的尖端负荷，使用各种类型的CTO导丝尝试进行肺动脉瓣穿孔。
结果
20例患者中有16例使用CTO导丝手术成功：9例使用Shinobi导丝，4例使用Miracle导丝，2例使用CROSS-IT导丝，1例使用Conquest Pro导丝。2例患者右心室流出道（RVOT）穿孔。1例患者需要进行心包穿刺以缓解心脏压塞。后来，该患者成功接受了杂交肺动脉瓣切开术。另1例患者接受了动脉导管（DA）支架置入术。3例出现体循环静脉淤血的患者需要进行球囊房间隔造口术。5例患者持续存在血氧饱和度降低，需要进行DA或RVOT支架置入术以增加肺血流量。有2例早期死亡和2例晚期死亡。平均随访时间为22.66±16个月。3例患者在随访期间接受了单心室和半心室修复以及1例Blalock-Taussig分流术。
结论
在部分室间隔完整的肺动脉闭锁病例中，使用CTO导丝可成功进行肺动脉瓣穿孔。
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