Department of Pediatric Cardiology, Institute of Cardio Vascular Diseases, Madras Medical Mission, Chennai, India.
Cardiol Young. 2021 Mar;31(3):358-370. doi: 10.1017/S1047951120003947. Epub 2020 Nov 16.
Ductal stents, right ventricular outflow tract stents, and aortopulmonary shunts are used to palliate newborns and infants with reduced pulmonary blood flow. Current long-term outcomes of these palliations from resource-restricted countries are unknown.
This single-centre, retrospective, observational study analysed the technical success, immediate and late mortality, re-interventions, and length of palliation in infants ≤5 kg who underwent aortopulmonary shunts, ductal, and pulmonary outflow stents. Patients were grouped by their anatomy.
There were 69 infants who underwent one of the palliations. Technical success was 90% for aortopulmonary shunts (n = 10), 91% for pulmonary outflow stents (n = 11) and 100% for ductal stents (n = 48). Early mortality within 30 days in 12/69 patients was observed in 20% after shunts, 9% after pulmonary outflow stents, and 19% after ductal stents. Late mortality in 11 patients was seen in 20% after shunts, 18% after outflow stents, and 15% after ductal stents. Seven patients needed re-interventions; two following shunts, one following outflow stent, and four following ductal stents for hypoxia. Among the anatomical groups, 10/12 patients with pulmonary atresia, intact ventricular septum survived after valvotomy and ductal stenting. Survival to Glenn shunt after ductal stent for pulmonary atresia, intact ventricular septum and diminutive right ventricle was very low in two out of eight patients, but very good (100%) for other univentricular hearts. Among 35 patients with biventricular lesions, 22 survived to the next stage.
Cyanotic infants, despite undergoing technically successful palliation had a high inter-stage mortality irrespective of the type of palliation. Duct stenting in univentricular hearts and in pulmonary atresia with an intact ventricular septum and adequate sized right ventricle tended to have low mortality and better long-term outcome. Completion of biventricular repair after palliation was achieved only in 63% of patients, reflecting unique challenges in developing countries despite advances in intensive care and interventions.
导管支架、右心室流出道支架和体肺分流术用于缓解肺血流量减少的新生儿和婴儿。目前资源有限国家对这些姑息治疗的长期结果尚不清楚。
这项单中心、回顾性、观察性研究分析了在体重≤5kg 的婴儿中进行体肺分流术、导管和肺流出道支架的技术成功率、即刻和晚期死亡率、再介入和姑息治疗的长度。患者根据解剖结构分组。
共有 69 名婴儿接受了一种姑息治疗。体肺分流术的技术成功率为 90%（n=10），肺流出道支架为 91%（n=11），导管支架为 100%（n=48）。69 例患者中有 12 例（12/69）在术后 30 天内出现早期死亡率，其中分流术为 20%，肺流出道支架为 9%，导管支架为 19%。11 例患者出现晚期死亡，其中分流术为 20%，流出道支架为 18%，导管支架为 15%。7 例患者需要再次介入治疗；2 例分流术后，1 例流出道支架术后，4 例导管支架术后因缺氧。在解剖学组中，12 例肺动脉瓣闭锁、室间隔完整的患者在瓣切开术和导管支架置入术后存活。2 例肺动脉瓣闭锁、室间隔完整、右心室较小的患者在导管支架置入后行 Glenn 分流术的存活率很低（8 例中的 2 例），但对于其他单心室心脏的存活率很高（100%）。在 35 例双心室病变患者中，有 22 例存活到下一阶段。
尽管姑息治疗技术上成功，但发绀婴儿的中间阶段死亡率很高，与姑息治疗的类型无关。在单心室心脏和肺动脉瓣闭锁、室间隔完整、右心室大小适中的患者中，导管支架置入术的死亡率较低，长期预后较好。尽管重症监护和干预措施有所进步，但在发展中国家，只有 63%的患者完成了双心室修复。
