Petit Christopher J, Qureshi Athar M, Glatz Andrew C, Kelleman Michael S, McCracken Courtney E, Ligon R Allen, Mozumdar Namrita, Whiteside Wendy, Khan Asra, Goldstein Bryan H
1Emory University School of Medicine,Children's Healthcare of Atlanta,Atlanta,GA,USA.
2Baylor College of Medicine, Texas Children's Hospital, Houston, TXUSA.
Cardiol Young. 2018 Aug;28(8):1042-1049. doi: 10.1017/S1047951118000756. Epub 2018 Jun 18.
Transcatheter right ventricle decompression in neonates with pulmonary atresia and intact ventricular septum is technically challenging, with risk of cardiac perforation and death. Further, despite successful right ventricle decompression, re-intervention on the pulmonary valve is common. The association between technical factors during right ventricle decompression and the risks of complications and re-intervention are not well described.
This is a multicentre retrospective study among the participating centres of the Congenital Catheterization Research Collaborative. Between 2005 and 2015, all neonates with pulmonary atresia and intact ventricular septum and attempted transcatheter right ventricle decompression were included. Technical factors evaluated included the use and characteristics of radiofrequency energy, maximal balloon-to-pulmonary valve annulus ratio, infundibular diameter, and right ventricle systolic pressure pre- and post-valvuloplasty (BPV). The primary end point was cardiac perforation or death; the secondary end point was re-intervention.
A total of 99 neonates underwent transcatheter right ventricle decompression at a median of 3 days (IQR 2-5) of age, including 63 patients by radiofrequency and 32 by wire perforation of the pulmonary valve. There were 32 complications including 10 (10.5%) cardiac perforations, of which two resulted in death. Cardiac perforation was associated with the use of radiofrequency (p=0.047), longer radiofrequency duration (3.5 versus 2.0 seconds, p=0.02), and higher maximal radiofrequency energy (7.5 versus 5.0 J, p<0.01) but not with patient weight (p=0.09), pulmonary valve diameter (p=0.23), or infundibular diameter (p=0.57). Re-intervention was performed in 36 patients and was associated with higher post-intervention right ventricle pressure (median 60 versus 50 mmHg, p=0.041) and residual valve gradient (median 15 versus 10 mmHg, p=0.046), but not with balloon-to-pulmonary valve annulus ratio, atmospheric pressure used during BPV, or the presence of a residual balloon waist during BPV. Re-intervention was not associated with any right ventricle anatomic characteristics, including pulmonary valve diameter.
Technical factors surrounding transcatheter right ventricle decompression in pulmonary atresia and intact ventricular septum influence the risk of procedural complications but not the risk of future re-intervention. Cardiac perforation is associated with the use of radiofrequency energy, as well as radiofrequency application characteristics. Re-intervention after right ventricle decompression for pulmonary atresia and intact ventricular septum is common and relates to haemodynamic measures surrounding initial BPV.
对于肺动脉闭锁且室间隔完整的新生儿，经导管右心室减压术在技术上具有挑战性，存在心脏穿孔和死亡风险。此外，尽管右心室减压成功，但肺动脉瓣再次干预很常见。右心室减压期间的技术因素与并发症和再次干预风险之间的关联尚未得到充分描述。
这是一项在先天性导管研究协作组参与中心进行的多中心回顾性研究。2005年至2015年期间，纳入所有肺动脉闭锁且室间隔完整并尝试经导管右心室减压的新生儿。评估的技术因素包括射频能量的使用和特性、最大球囊与肺动脉瓣环比值、漏斗部直径以及瓣膜成形术前和术后的右心室收缩压。主要终点是心脏穿孔或死亡；次要终点是再次干预。
共有99例新生儿在中位年龄3天（四分位间距2 - 5天）时接受了经导管右心室减压，其中63例采用射频，32例采用肺动脉瓣钢丝穿孔。发生32例并发症，包括10例（10.5%）心脏穿孔，其中2例导致死亡。心脏穿孔与射频能量的使用有关（p = 0.047）、射频持续时间较长（3.5秒对2.0秒，p = 0.02）以及最大射频能量较高（7.5焦耳对5.0焦耳，p < 0.01），但与患者体重（p = 0.09）、肺动脉瓣直径（p = 0.23）或漏斗部直径（p = 0.57）无关。36例患者进行了再次干预，这与干预后较高的右心室压力有关（中位值60对50 mmHg，p = 0.041）和残余瓣膜压差有关（中位值15对10 mmHg，p = 0.046），但与球囊与肺动脉瓣环比值、瓣膜成形术期间使用的大气压或瓣膜成形术期间残余球囊腰部的存在无关。再次干预与任何右心室解剖特征无关，包括肺动脉瓣直径。
肺动脉闭锁且室间隔完整的经导管右心室减压周围的技术因素影响手术并发症风险，但不影响未来再次干预风险。心脏穿孔与射频能量的使用以及射频应用特征有关。肺动脉闭锁且室间隔完整的右心室减压术后再次干预很常见，并且与初始瓣膜成形术周围的血流动力学指标有关。
