Division of Pediatric Cardiology, Children's Healthcare of Atlanta/Emory University School of Medicine, 2835 Brandywine Road, Suite 400, Atlanta, 30341, GA, USA.
Cook Children's Medical Center, Fort Worth, TX, USA.
Pediatr Cardiol. 2021 Feb;42(2):302-306. doi: 10.1007/s00246-020-02483-z. Epub 2020 Oct 10.
We describe our experience with aortic root distortion in transcatheter pulmonary valve implantation (TPVI). Aortic root distortion (AD) can be observed with balloon angioplasty of the right ventricular outflow tract (RVOT), but its long-term significance is unknown. This has been a common finding in our institution, though not fully appreciated in our early experience. Retrospective review of procedural angiograms prior to TPVI and follow up imaging was performed. Between June 2012 and October 2017, 47 patients underwent catheterization to attempt TPVI. Five patients had coronary compression which precluded TPVI (one with significant AD as well). Four patients had significant AD and did not receive TPVI. Of the remaining 38 successful TPVI, 20 had adequate imaging to assess the aortic root. Four patients had severe AD, 7 had mild AD, and 9 with no AD. Severity of AI did not correlate with degree of AD. Median follow up after TPVI was 46 months (IQR 21-67). Of the 4 patients with severe AD who received TPVI, 1 has new mild AI with 78 months follow up. Of the 18 patients who received TPVI without adequate arch imaging, 2 patients have new mild AI with 86 and 75 months follow up. AD during RVOT angioplasty is a relatively common finding. In our early experience, some patients who were retrospectively identified to have severe AD received TPVI. These patients have done well, though further data is needed before considering severe AD a benign finding.
我们描述了在经导管肺动脉瓣植入术（TPVI）中主动脉根部扭曲的经验。右心室流出道（RVOT）球囊血管成形术中可观察到主动脉根部扭曲（AD），但其长期意义尚不清楚。这在我们机构中是一种常见的发现，但在我们的早期经验中并没有完全认识到。对 TPVI 前的程序血管造影和随访影像学进行回顾性分析。2012 年 6 月至 2017 年 10 月，47 例患者接受了导管插入术以尝试 TPVI。5 例患者有冠状动脉压迫，无法进行 TPVI（其中 1 例有明显的 AD）。4 例患者有明显的 AD，未进行 TPVI。在其余 38 例成功的 TPVI 中，20 例有足够的影像学评估主动脉根部。4 例患者有严重的 AD，7 例有轻度 AD，9 例无 AD。AI 的严重程度与 AD 的严重程度无关。TPVI 后中位随访时间为 46 个月（IQR 21-67）。在接受 TPVI 的 4 例严重 AD 患者中，1 例在 78 个月随访时出现新的轻度 AI。在接受 TPVI 但没有充分弓部成像的 18 例患者中，2 例在 86 和 75 个月随访时出现新的轻度 AI。RVOT 血管成形术中的 AD 是一种相对常见的发现。在我们的早期经验中，一些被回顾性识别为严重 AD 的患者接受了 TPVI。这些患者情况良好，但在考虑严重 AD 为良性发现之前，还需要更多的数据。
