Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany.
Department for Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilians University Munich, 81377 Munich, Germany.
Int J Cardiol. 2021 Feb 15;325:45-50. doi: 10.1016/j.ijcard.2020.10.017. Epub 2020 Oct 10.
Conduit dilatation above 110% and TPVI in conduits <16 mm is not recommended. However, if we want to reach normal values for RVOT diameters and diminish reintervention rates, pushing these boundaries is essential.
Analysis of subsequent patients who underwent TPVI with Edwards Sapien valves in conduits ≤16 mm between 2010 and 2020.
In n = 33 cases median age was 13 years (5-20 y) and median weight 47 kg (15-91 kg). Preexisting RVOT grafts were n = 28 Contegra® conduits and n = 5 homografts (12 mm n = 15; 14 mm n = 11; 16 mm n = 7). Implanted were the Sapien (n = 8), Sapien XT (n = 10) and Sapien 3 valve (n = 15) with 20 mm (n = 4), 23 mm (n = 19), 26 mm (n = 9) and 29 mm (n = 1). Mean minimal RVOT diameter after TPVI was 22,7 ± 2,3 mm (18-30 mm) which is 150% of the mean minimal RVOT diameter before TPVI (15,1 ± 4,3 mm). Covered stents were used in n = 10 cases. Contained conduit rupture occurred in n = 7 cases (21%). Residual RVOT gradients of 5,7 ± 4,9 mmHg (0-18 mmHg) showed adequate RV unloading.
TPVI could be performed successfully in all patients. Dilatation above 150% and a valve/conduit diameter ratio up to 2,4 were well tolerated. There was a considerable amount of conduit rupture but all were confined without further need for intervention or surgery.
不建议在导管扩张超过 110%和导管内 TPVI 小于 16mm 的情况下进行。然而，如果我们想要达到 RVOT 直径的正常数值并降低再次介入的比率，那么推挤这些界限是至关重要的。
分析 2010 年至 2020 年间接受 Edwards Sapien 瓣膜在≤16mm 导管内 TPVI 的后续患者。
在 n=33 例中，中位年龄为 13 岁（5-20 岁），中位体重为 47kg（15-91kg）。存在预先存在的 RVOT 移植物的患者有 n=28 例的 Contegra®导管和 n=5 例同种异体移植物（12mm n=15；14mm n=11；16mm n=7）。植入的瓣膜有 Sapien（n=8）、Sapien XT（n=10）和 Sapien 3 瓣膜（n=15），分别有 20mm（n=4）、23mm（n=19）、26mm（n=9）和 29mm（n=1）。TPVI 后 RVOT 的最小直径平均值为 22.7±2.3mm（18-30mm），是 TPVI 前 RVOT 的最小直径平均值（15.1±4.3mm）的 150%。在 n=10 例中使用了覆盖支架。在 n=7 例（21%）中发生了包裹的导管破裂。残余的 RVOT 梯度为 5.7±4.9mmHg（0-18mmHg），表明 RVOT 充分卸载。
所有患者都能成功地进行 TPVI。扩张超过 150%和瓣膜/导管直径比高达 2.4 都能得到很好的耐受。有相当数量的导管破裂，但都被限制在没有进一步需要干预或手术的范围内。
