Lefort Bruno, Saint-Etienne Christophe, Soulé Nathalie, Ma Iris, Dion Fanny, Chantepie Alain
Cardiologie congénitale, Centre Hospitalier Universitaire de Tours, Tours, France.
Université François Rabelais, Tours, France.
Congenit Heart Dis. 2019 Sep;14(5):814-818. doi: 10.1111/chd.12812. Epub 2019 Jul 10.
Chronic total occlusion (CTO) guidewire have been recently reported as an alternative to radiofrequency for perforating atretic pulmonary valve. Since procedure failures or perforation of the right ventricle still occurred with CTO, we tried to enhance the stability, steering, and pushability of the wire using a microcatheter in order to improve the safety and efficacy of the procedure.
We performed pulmonary valve perforation with CTO guidewire and microcatheter in five consecutive newborns with pulmonary atresia with intact ventricular septum (PA-IVS) under fluoroscopic and echocardiographic control.
The valve was easily perforated at the first attempt for all patients. After perforation, the microcatheter positioned in the main pulmonary artery allowed the exchange of the CTO guidewire for a more flexible wire, avoiding lesion and facilitating manipulation in the distal pulmonary branch arteries. The pulmonary valve was then dilated with balloons of increasing size as usually performed. We did not experience any procedural or early complications. Blalock-Taussig shunt was performed in 2 children because of a persistent cyanosis, 4 and 10 days after perforation.
The combined use of a CTO guide and a microcatheter appears to be a safe and reliable technique for perforating the pulmonary valve of newborns with PA-IVS. Further procedures with this approach are needed to confirm this first experience.
最近有报道称慢性完全闭塞（CTO）导丝可替代射频用于穿透闭锁的肺动脉瓣。由于使用CTO导丝仍会出现手术失败或右心室穿孔的情况，我们尝试通过使用微导管来增强导丝的稳定性、操控性和推送性，以提高手术的安全性和有效性。
在透视和超声心动图引导下，我们对5例连续的室间隔完整的肺动脉闭锁（PA-IVS）新生儿使用CTO导丝和微导管进行肺动脉瓣穿孔术。
所有患者均在首次尝试时轻松完成瓣膜穿孔。穿孔后，置于主肺动脉的微导管允许将CTO导丝更换为更柔软的导丝，避免了损伤并便于在远端肺分支动脉中操作。然后像通常那样用尺寸逐渐增大的球囊扩张肺动脉瓣。我们未经历任何手术相关或早期并发症。2例患儿因穿孔后4天和10天持续存在青紫而进行了Blalock-Taussig分流术。
CTO导丝与微导管联合使用似乎是一种安全可靠的技术，可用于对PA-IVS新生儿的肺动脉瓣进行穿孔。需要采用这种方法进行进一步的手术来证实这一初步经验。
