Skoglund Kristofer, Clase Ludvig, Dellborg Mikael
Hallands Hospital Kungsbacka, Sweden, and Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden,
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
J Multidiscip Healthc. 2018 Jul 16;11:333-338. doi: 10.2147/JMDH.S165269. eCollection 2018.
Among patients with congenital heart disease, implantation of a valved conduit is common practice for surgical reconstruction of malformations involving the right ventricular outflow tract (RVOT). The conduit has limited durability, and treatments with surgical replacement and transcatheter pulmonary valve replacement (TPVR) are common. Previous studies indicate that TPVR, despite being a less invasive alternative, is not used for the majority of these patients.
This is a descriptive study of the medical records of 100 consecutive adult patients with RVOT malformations who were evaluated a total of 118 times between January 1, 2008 and December 31, 2015, at meetings of the hospital's multidisciplinary heart patient review board, in which relevant specialists make all treatment decisions on each case through a consensus process. The most common overall outcome decision was surgical conduit implantation. In 51 cases, the patient had a pre-existing conduit and, of those, 16 cases were recommended for TPVR. In seven of those 16, TPVR could not be performed, most commonly due to the risk of coronary compression or unfavorable conduit anatomy.
Among patients with congenital heart disease involving the RVOT, surgical conduit implantation was the main treatment both in native RVOT malformations and in the case of a pre-existing dysfunctional conduit, despite the introduction of TPVR. Although the hospital's multidisciplinary heart patient review board often recommended TPVR, it was found to be unfeasible in many cases. The main reasons were risk of coronary compression and unfavorable conduit anatomy.
在先天性心脏病患者中，植入带瓣管道是对涉及右心室流出道（RVOT）的畸形进行手术重建的常用方法。该管道耐久性有限，手术置换和经导管肺动脉瓣置换术（TPVR）是常见的治疗方法。先前的研究表明，尽管TPVR是一种侵入性较小的替代方法，但大多数此类患者并未采用。
这是一项对100例连续成年RVOT畸形患者病历的描述性研究，这些患者在2008年1月1日至2015年12月31日期间，在医院多学科心脏患者评审委员会会议上共接受了118次评估，相关专家通过共识过程对每个病例做出所有治疗决定。最常见的总体治疗决定是手术植入管道。在51例患者中，患者已有管道，其中16例被推荐进行TPVR。在这16例中的7例中，无法进行TPVR，最常见的原因是冠状动脉受压风险或管道解剖结构不理想。
在涉及RVOT的先天性心脏病患者中，尽管引入了TPVR，但手术植入管道仍是原发性RVOT畸形和已有功能失调管道情况下的主要治疗方法。尽管医院多学科心脏患者评审委员会经常推荐TPVR，但发现在许多情况下不可行。主要原因是冠状动脉受压风险和管道解剖结构不理想。
