Fiszer Roland, Dryżek Paweł, Szkutnik Małgorzata, Góreczny Sebastian, Krawczuk Alexandra, Moll Jadwiga, Moszura Tomasz, Pawlak Szymon, Białkowski Jacek
Silesian Center for Heart Diseases Department of Congenital Heart Diseases and Pediatric Cardiology.
Cardiol J. 2017;24(6):604-611. doi: 10.5603/CJ.a2017.0023. Epub 2017 Mar 1.
Transcutaneous pulmonary valve replacement (TPVR) has become an alternative to heart surgery for patients after previous right ventricular outflow tract (RVOT) or pulmonary artery (PA) surgical interventions. The objective was to present immediate and long-term outcomes of trans¬cutaneous pulmonary valve replacement.
Between 06/2009 and 06/2016, 46 patients underwent TPVR. Initial diagnoses included tetralogy of Fallot, common arterial trunk, transposition of great arteries post Rastelli correction, left ventricle outflow obstruction after Ross operation, pulmonary atresia, and isolated dysplastic pulmonary valve stenosis. Thirty eight (78%) patients had previously implanted conduits in the pulmonary position, the rest had either RVOT patch reconstruction (n = 6; 13%) or biological valve implantation (n = 2; 4%). They presented primarily with pulmonary stenosis (n = 18; 39%) or regurgitation (n = 28; 60%).
All procedures were successful - 44 Melody and 2 Edwards-Sapien valves were implanted. Before each procedure exclusion of potential coronary compression and RVOT prestenting was performed. Significant RVOT systolic gradient reduction (from 35.3 ± 19.5 to 13.5 ± 7.1 mm Hg; p < 0.001) and decrease of right to left ventricle systolic pressure ratio from 0.58 ± 0.18 to mean 0.37 ± 0.1 (p < 0.001) was achieved. Also, in every patient PA-RVOT competence was restored, with minor in¬competence in only a few patients. Post procedure follow-up ranged from 2 to 86 (mean 35.2) months. Follow-up fluoroscopy or chest X-ray revealed 6 stent fractures (2 stent defragmentation - with only 1 significant valve stenosis).
Transcutaneous pulmonary valve replacement is a safe procedure with encouraging results, it also enables deferring surgical reintervention in the majority of patients.
经皮肺动脉瓣置换术（TPVR）已成为曾接受右心室流出道（RVOT）或肺动脉（PA）外科手术干预患者心脏手术的替代方案。目的是介绍经皮肺动脉瓣置换术的近期和长期疗效。
2009年6月至2016年6月期间，46例患者接受了TPVR。初始诊断包括法洛四联症、共同动脉干、Rastelli矫正术后大动脉转位、Ross手术后左心室流出道梗阻、肺动脉闭锁以及孤立性发育不良性肺动脉瓣狭窄。38例（78%）患者先前已在肺动脉位置植入导管，其余患者接受了RVOT补片重建（n = 6；13%）或生物瓣膜植入（n = 2；4%）。他们主要表现为肺动脉狭窄（n = 18；39%）或反流（n = 28；60%）。
所有手术均成功——植入了44枚Melody瓣膜和2枚Edwards-Sapien瓣膜。在每次手术前，均排除了潜在的冠状动脉压迫并进行了RVOT预支架植入。实现了RVOT收缩期压差显著降低（从35.3±19.5降至13.5±7.1 mmHg；p < 0.001），右心室与左心室收缩压比值从0.58±0.18降至平均0.37±0.1（p < 0.001）。此外，每位患者的PA-RVOT功能均得以恢复，仅有少数患者存在轻度功能不全。术后随访时间为2至86个月（平均35.2个月）。随访荧光透视或胸部X线检查发现6例支架骨折（2例支架碎片——仅1例出现显著瓣膜狭窄）。
经皮肺动脉瓣置换术是一种安全的手术，疗效令人鼓舞，还能使大多数患者推迟再次手术干预。
