Li Jiawen, Li Gang, Shi Xiaoqing, Wang Chuan, Duan Hongyu, Zhou Kaiyu, Hua Yimin, Li Yifei
Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China.
Ministry of Education Key Laboratory of Women and Children's Diseases and Birth Defects, West China Second University Hospital, Sichuan University, Chengdu, China.
Front Pediatr. 2020 Dec 21;8:572238. doi: 10.3389/fped.2020.572238. eCollection 2020.
Percutaneous balloon valvuloplasty (PBPV) is recommended as a first-choice treatment for critical pulmonary stenosis (CPS). A concept of perinatal integrative management has been developed. Unfortunately, the evidence on the advantage of integrative management for CPS during the perinatal period is absent. Single-center, observational, preliminary research has been developed, and three groups have been enrolled. There were 42 children with CPS enrolled for this study between January 2014 and December 2017 in our center, and their follow-up duration is at least 1 year. Three groups were set up: the integrative perinatal management group (group I), who received prenatal diagnosis with perinatal management to maintain circulation and an optimized PBPV procedure; the prenatal diagnosis group (group PR), who received a diagnosis of pulmonary stenosis before birth without any monitoring and perinatal management; and the postnatal diagnosis group (group PO), who received the CPS diagnosis after birth. There were 13 patients enrolled in group I, 11 babies enrolled in group PR, and 18 cases included in group PO. Integrative management helped to put the timing of PBPV in advance. The age for PBPV in group I was 9.38 ± 5.58 days, and groups PR and PO were 24.54 ± 4.87 and 49.11 ± 9.50 days, respectively. The average peak transvalvular gradient (PGs) of the perinatal management group (group I) and prenatal diagnosis group (group PR) remained at a stable level. However, the average PGs of group PO were progressively elevated during follow-up. Moreover, the follow-up data from group I revealed an advantage in RV development and functional restoration. There was no difference among the three groups in the ratio of reintervention and postoperative moderate pulmonary regurgitation during 1-year follow-up ( >0.05). Prenatal diagnosis helps to improve the outcomes of PBPV. Moreover, perinatal integrative medical management enhances the advantage of prenatal diagnosis. However, this research is still a small-size cohort study, and the limited population number and follow-up duration were the major limitations to expand the conclusions.
经皮球囊瓣膜成形术（PBPV）被推荐作为重度肺动脉狭窄（CPS）的首选治疗方法。一种围产期综合管理的概念已经形成。不幸的是，目前尚无关于围产期CPS综合管理优势的证据。已开展了单中心、观察性的初步研究，并纳入了三组。2014年1月至2017年12月期间，我们中心有42例CPS患儿纳入本研究，其随访时间至少为1年。设立了三组：围产期综合管理组（I组），接受产前诊断并进行围产期管理以维持循环及优化的PBPV手术；产前诊断组（PR组），在出生前被诊断为肺动脉狭窄，但未进行任何监测和围产期管理；产后诊断组（PO组），在出生后被诊断为CPS。I组纳入13例患者，PR组纳入11例婴儿，PO组纳入18例。综合管理有助于提前PBPV的时机。I组PBPV的年龄为9.38±5.58天，PR组和PO组分别为24.54±4.87天和49.11±9.50天。围产期管理组（I组）和产前诊断组（PR组）的平均跨瓣峰值压差（PGs）保持在稳定水平。然而，PO组的平均PGs在随访期间逐渐升高。此外，I组的随访数据显示在右心室发育和功能恢复方面具有优势。在1年随访期间，三组在再次干预率和术后中度肺动脉反流方面无差异（>0.05）。产前诊断有助于改善PBPV的结局。此外，围产期综合医疗管理增强了产前诊断的优势。然而，本研究仍是一项小样本队列研究，有限的样本量和随访时间是扩大研究结论的主要局限性。
