Department of Medicine, Duke University, Durham, NC.
Division of Cardiology, Department of Medicine, Duke University, Durham, NC.
Prog Cardiovasc Dis. 2018 Sep-Oct;61(3-4):347-359. doi: 10.1016/j.pcad.2018.09.003. Epub 2018 Sep 17.
Pulmonary and/or tricuspid valve dysfunction is common among individuals with congenital heart disease, and surgical intervention often carries prohibitive risks. Transcatheter valve replacement (TVR) of the right-sided cardiac valves has become a viable treatment option over the past two decades, while continued technological development aims to broaden its applicability to an even larger portion of those with repaired congenital heart disease. To date, two transcatheter valves have been approved for use in patients with dysfunctional right ventricular to pulmonary artery conduits as well as those with failing pulmonic bioprosthetic valves, and are also used off-label in the "native" RVOT and within surgically repaired/replaced but failing tricuspid valves. TVR has demonstrated comparable safety and short-term outcomes to that of surgical valve replacement. This article aims to review current available devices, focusing on their safety, efficacy and on and off label usage, while briefly describing some of the emerging devices and novel procedural techniques that will likely lead to significant expansion of transcatheter treatment of right sided valve disease in the future.
肺和/或三尖瓣功能障碍在先天性心脏病患者中很常见,手术干预往往风险极高。在过去的二十年中,经导管心脏瓣膜置换术(TVR)已成为一种可行的治疗选择,而持续的技术发展旨在将其适用范围扩大到更多接受过先天性心脏病修复的患者。迄今为止,已有两种经导管瓣膜获批用于右心室至肺动脉通道功能障碍的患者以及瓣叶功能不良的生物瓣患者,也被超适应证应用于“原生”RVOT 以及外科修复/置换但功能不良的三尖瓣。TVR 的安全性和短期疗效与外科瓣膜置换相当。本文旨在综述目前可用的器械,重点关注其安全性、疗效和适应证及超适应证应用,并简要描述一些新兴器械和新的介入技术,这些器械和技术可能会在未来显著扩大经导管治疗右心瓣膜疾病的范围。