Valderrama Paulo, Garay Francisco, Springmüller Daniel, Briones Yeny, Aguirre Daniel, González Rodrigo, Becker Pedro, Zamora Guillermo, Sánchez Luis, Castillo Gabriel, Palominos Gilberto, Cárdenas Luis
Department of Pediatric Cardiology, Respiratory and Cardiovascular Diseases, Division of Pediatrics, Faculty of Medicine, Pontifical Catholic University of Chile, Santiago, Chile.
Cardiovascular Center Dr. Luis Calvo Mackenna Hospital, Chilean Public Health Network, Av. Antonio Varas Nº 360, 7500539, Santiago, Chile.
Pediatr Cardiol. 2020 Apr;41(4):837-842. doi: 10.1007/s00246-020-02321-2. Epub 2020 Feb 27.
Tetralogy of Fallot (ToF) treatment is difficult in patients with surgical risk factors or unfavorable anatomy. Stent implantation in the right ventricular outflow tract (RVOT) is an option for these patients. We report our initial experience in Chile with RVOT stenting in patients with ToF. Retrospective and descriptive study conducted in three pediatric cardiovascular centers in Chile between 2012 and 2015, including all ToF patients with stent in the RVOT as first procedure. Clinical records, echocardiographic, interventional, and surgical reports were reviewed for demographics and information of RVOT and pulmonary arteries. 12 newborns with ToF were included (75% female). Median age was 20 days (1-70) and mean weight was 2178 g (1400-3414). Saturations increased after the procedure from 74.3% (55-88) to 88.5% (80-98%), (p < 0.01). No complications or mortality were related to interventions. Follow-up was 11 months (7-36). Median right and left pulmonary arteries Z-score increased from - 4.0 (- 5.2 to - 0.3) and - 1.5 (- 4.8 to - 0.26) to + 0.53 (0.0 to 2.2) and + 1.1 (0.5 to 2.9), (p < 0.05), respectively. Nakata index increased from 63 mm/mm (35 to 143) to 162 mm/mm (107 to 197), (p < 0.05). Surgical repair was performed at a median of 4 months (2-7). Transannular patch repair was necessary in all patients and there was no surgical mortality. RVOT stenting is a safe and useful option for patients with ToF and surgical risk factors or unfavorable anatomy. It increases the pulmonary blood flow, improving saturation and pulmonary artery growth as a bridge for surgical repair.
对于存在手术风险因素或解剖结构不利的法洛四联症（ToF）患者，其治疗颇具难度。右心室流出道（RVOT）支架植入术是这类患者的一种选择。我们报告了在智利对ToF患者进行RVOT支架植入术的初步经验。2012年至2015年间，在智利的三个儿科心血管中心开展了一项回顾性描述性研究，纳入所有首次接受RVOT支架植入术的ToF患者。查阅临床记录、超声心动图、介入及手术报告，以获取人口统计学信息以及RVOT和肺动脉的相关信息。纳入了12例ToF新生儿（75%为女性）。中位年龄为20天（1 - 70天），平均体重为2178克（1400 - 3414克）。术后饱和度从74.3%（55 - 88）升至88.5%（80 - 98%），（p < 0.01）。未发生与干预相关的并发症或死亡情况。随访时间为11个月（7 - 36个月）。右肺动脉和左肺动脉的中位Z值分别从 - 4.0（ - 5.2至 - 0.3）和 - 1.5（ - 4.8至 - 0.26）增至 + 0.53（0.0至2.2）和 + 1.1（0.5至2.9），（p < 0.05）。中田指数从63平方毫米/毫米（35至143）增至162平方毫米/毫米（107至197），（p < 0.05）。手术修复的中位时间为4个月（2 - 7个月）。所有患者均需进行跨环补片修复，且无手术死亡病例。对于有手术风险因素或解剖结构不利的ToF患者，RVOT支架植入术是一种安全且有效的选择。它可增加肺血流量，改善饱和度并促进肺动脉生长，作为手术修复的桥梁。
