El Shedoudy Sahar, El-Doklah Eman
Cardiology Department, Tanta University Hospitals, Tanta, Egypt.
J Saudi Heart Assoc. 2018 Jul;30(3):222-232. doi: 10.1016/j.jsha.2018.01.002. Epub 2018 Jan 31.
To evaluate the safety of using the stiff end of a coronary wire to perforate an atretic pulmonary valve (PV) in patients with pulmonary atresia with intact ventricular septum (PAIVS).
Radiofrequency perforation is an accepted modality to perforate the PV in patients PAIVS. However, the high cost precludes its widespread use.
This is a single-center experience that spanned from March 2013 to January 2016 and involved 13 neonates who were severely cyanotic with PAIVS and with ductal-dependent pulmonary circulation. The stiff end of a coronary wire was used to perforate the atretic PV anterogradely, followed by balloon pulmonary valvuloplasty.
The mean age of patients was 3.9 ± 2.7 days and their mean weight was 2.8 ± 0.19 kg. The mean oxygen saturation was 77.1 ± 3.2%. All had membranous pulmonary atresia, with patent infundibulum and tripartite right ventricle. The valve was successfully perforated in 11 out of 13 patients. Death occurred in two patients (15.4%) owing to heart failure and sepsis. Patent ductus arteriosus stenting was performed 2 days after the procedure in one patient because of cyanosis followed by one and half ventricle repair at of age 5 months. Two patients (15.4%) had one and a half ventricle repair at age of 5 months and 6 months owing to insufficient anterograde pulmonary flow. Two patients (15.4%) underwent second intervention with balloon dilatation of the valve. The remaining seven patients (53.8%) had no further intervention. Two cases (15.4%) had femoral artery thrombosis treated with streptokinase. The mean duration of follow-up was 13.17 ± 7 months. There was significant improvement in the degree of tricuspid incompetence. There was a significant growth in the tricuspid valve annulus during the follow-up (the mean score increased from -0.8 ± 0.9 to 0.1 ± 0.9) ( = 0.003). There was also a significant increase in the tricuspid valve annulus/mitral valve annulus ratio as its mean increased from 0.73 ± 0.10 to 0.86 ± 0.11 during follow-up ( < 0.001).
Perforation of the atretic PV in selected cases with membranous atresia and patent infundibulum using the stiff end of a coronary wire is an effective alternative to using radiofrequency perforation.
评估在室间隔完整的肺动脉闭锁（PAIVS）患者中使用冠状动脉导丝硬端穿刺闭锁肺动脉瓣（PV）的安全性。
射频穿孔是PAIVS患者中用于穿刺PV的一种公认方法。然而，高成本限制了其广泛应用。
这是一项单中心经验，时间跨度为2013年3月至2016年1月，涉及13例患有严重青紫型PAIVS且依赖动脉导管维持肺循环的新生儿。使用冠状动脉导丝硬端经前向穿刺闭锁的PV，随后进行球囊肺动脉瓣成形术。
患者的平均年龄为3.9±2.7天，平均体重为2.8±0.19千克。平均血氧饱和度为77.1±3.2%。所有患者均为膜性肺动脉闭锁，漏斗部通畅，右心室呈三部分结构。13例患者中有11例成功穿刺瓣膜。2例患者（15.4%）因心力衰竭和败血症死亡。1例患者术后2天因青紫进行动脉导管未闭支架置入术，随后在5个月大时进行了单心室合并半心室修复术。2例患者（15.4%）因前向肺血流不足在5个月和6个月大时进行了单心室合并半心室修复术。2例患者（15.4%）接受了瓣膜球囊扩张的二次干预。其余7例患者（53.8%）未进行进一步干预。2例患者（15.4%）发生股动脉血栓，用链激酶治疗。平均随访时间为13.17±7个月。三尖瓣反流程度有显著改善。随访期间三尖瓣环有显著增大（平均评分从-0.8±0.9增加到0.1±0.9）（P=0.003）。三尖瓣环与二尖瓣环比值也有显著增加，随访期间其平均值从0.73±0.10增加到0.86±0.11（P<0.001）。
在选定的膜性闭锁且漏斗部通畅的病例中，使用冠状动脉导丝硬端穿刺闭锁的PV是替代射频穿孔的一种有效方法。
