Nasser Bana Agha, Abdulrahman Mesned, Qwaee Abdullah A L, Alakfash Ali, Mohamad Tageldein, Kabbani Mohamed S
Pediatric cardiac surgical intensive care, Prince Sultan Cardiac Center, Qassim, Saudi Arabia.
Pediatric cardiology department, Prince Sultan Cardiac Center, Qassim, Saudi Arabia.
J Saudi Heart Assoc. 2020 Apr 17;32(1):86-92. doi: 10.37616/2212-5043.1014. eCollection 2020.
Ducts-dependent pulmonary circulation is spectrum of congenital heart diseases that need urgent intervention to augment pulmonary blood. Systemic to pulmonary shunt is the classical surgical management. Stenting of ductus arteriosus emerged in the last 2 decades as an alternative plausible intervention.
To evaluate and compare the short and midterm effects of PDA stenting in compared to surgically placed shunt for augmentation of pulmonary blood flow looking to pulmonary artery (PA) branches growth, oxygen saturation and suitability for second stage repair.
We conducted this prospective study in Cardiac Surgical Intensive Care Unit. Cases were divided into "stent group" and "surgical shunt" group. Results were compared between two groups regarding oxygen saturation, mechanical ventilation duration, intensive care stay, mortality and morbidity. Growth of PA branches was assessed during follow up by echocardiograph. Nakata index score was calculated by angiogram before second stage surgery and was compared between both groups.
43 patients were included. Forty-two cases were offered stent as initial management. 6/42 cases failed stenting (14%) and 3/42 (7%) required late BT shunt after PDA stenting. 10/43 cases ended up receiving BT shunt and were counted as "surgical shunt group". Stent group (33 cases) needed less mechanical ventilation (2.08 ± 0.65 vs.7.8 ± 4 days with p = 0.014), and less ICU stay compared with surgical shunt group (6.2 ± 1.02 vs. 14 ± 4.5 days, P = 0.009). Both groups achieved similar growth of pulmonary artery branches (p = 0.6 for Z score of left pulmonary artery and P = 0.8 for Z score for right pulmonary artery). Although "stent group" reached second stage surgery with lower O2 saturation 67.6 ± 4.6 vs. 80 ± 4.2 in "surgical shunt" group with P value = 0.0002). Majority of patients in both groups had some PA distortion and needed surgical reconstruction in main pulmonary artery or in its main branches during second stage repair. 3 cases (7.1%) died soon post stenting versus none in surgical shunt group ( = value 0.57).
In neonates with ductus-dependent pulmonary circulation PDA stenting can be introduced as safe first possible option to augment pulmonary blood flow with good outcome and suitable preparation for second stage palliation.
依赖导管的肺循环是一系列需要紧急干预以增加肺血流量的先天性心脏病。体肺分流术是经典的外科治疗方法。动脉导管支架置入术在过去20年中作为一种可行的替代干预措施出现。
评估和比较动脉导管未闭（PDA）支架置入术与外科分流术在增加肺血流量方面的短期和中期效果，观察肺动脉（PA）分支生长、氧饱和度以及对二期修复的适用性。
我们在心脏外科重症监护病房进行了这项前瞻性研究。病例分为“支架组”和“外科分流组”。比较两组在氧饱和度、机械通气时间、重症监护停留时间、死亡率和发病率方面的结果。随访期间通过超声心动图评估PA分支的生长情况。二期手术前通过血管造影计算中田指数评分，并在两组之间进行比较。
纳入43例患者。42例患者最初接受支架治疗。6/42例支架置入失败（14%），3/42例（7%）在PDA支架置入术后需要晚期体肺分流术。10/43例最终接受了体肺分流术，并被计入“外科分流组”。与外科分流组相比，支架组（33例）机械通气时间更短（2.08±0.65天对7.8±4天，p = 0.014），重症监护停留时间更短（6.2±1.02天对14±4.5天，P = 0.009）。两组肺动脉分支生长情况相似（左肺动脉Z评分p = 0.6，右肺动脉Z评分P = 0.8）。尽管“支架组”二期手术时氧饱和度较低（67.6±4.6对“外科分流”组的80±4.2，P值 = 0.0002）。两组大多数患者在二期修复时主肺动脉或其主要分支存在一些PA扭曲，需要手术重建。3例（7.1%）在支架置入后不久死亡，而外科分流组无死亡病例（P值 = 0.57）。
对于依赖导管的肺循环新生儿，PDA支架置入术可作为安全的首选方法来增加肺血流量，效果良好，并为二期姑息治疗做好适当准备。
