Department of Pediatric Cardiology, Istanbul Health Scıence University, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istasyonmahallesi Turgut Özal Bulvarı Küçükçekmece, 34303, Istanbul, Turkey.
Department of Pediatric Cardiology, Istanbul Medipol Universıty, Istanbul, Turkey.
Pediatr Cardiol. 2021 Jun;42(5):1041-1048. doi: 10.1007/s00246-021-02578-1. Epub 2021 Apr 12.
Pulmonary valve atresia with intact ventricular septum (PA-IVS) can be treated either surgically or transcatheterly for eligible patients. Perforation of pulmonary valves using chronic total occlusion (CTO) guidewires has been reported as an alternative to radiofrequency (RF) perforation. We sought to report our experience with CTO guidewires for perforation of atretic pulmonary valves and subsequent balloon dilatation (with or without patent ductus arteriosus stenting) in patients with PA-IVS from two centers. A retrospective study was carried out on PA-IVS patients who underwent intervention between March 2014 and September 2019, in which CTO guidewire was employed for pulmonary valve perforation. A total of 26 patients were identified. The median age and weight of the patients were 5.2 days (range 1-21 days) and 3.1 kg (range 2.2-3.8 kg), respectively. All patients were situs solitus, except one patient with left atrial isomerism. The right ventricle (RV) morphology was bipartite in 22/26 patients and tripartite in 4/26 patients. Before the procedure, the mean saturation was 76% (range 70-86%) while the patients were under prostaglandin infusion. The pulmonary valve perforation attempt was performed with the Asahi Conquest Pro 9 CTO wire (n = 6) or Asahi Pro 12 CTO wire (n = 18) and/or Asahi Miracle CTO wire (n = 2). The procedure was successful in 20/26 (77%) patients using CTO wires. We analyzed the efficiency of CTO wire based on the subtypes: Conquest Pro 9 in 6/6 (100%) patients, Conquest Pro 12 in 12/18 (67%) patients, and Miracle in 2/2 (100%) patients. Before CTO wire usage in 3 patients, radiofrequency (RF) perforation was unsuccessful. Among these 3 patients, pulmonary valve perforation was successful in 2 patients with CTO wire; hence, in the remaining patient, perforation was also unsuccessful with CTO wire. After CTO wire perforation was unsuccessful in 6 patients, RF perforation was attempted in 3 patients (2 successful attempts and 1 unsuccessful attempts), and one patient as referred to surgery. Desaturation was persistent in 19 cases, which necessitated ductus arteriosus stenting. Early procedural complication was observed in 3/26 (11%) patients. Two of these patients had vascular complications due to the sheath, which was treated with heparin infusion and streptokinase, and the remaining patient had sudden bradycardia and cardiac arrest during the procedure and did not respond to cardiac resuscitation. CTO wires should be keep in mind for atretic pulmonary valve perforation as a first choice or when RF perforation is unsuccessful.
伴有完整室间隔的肺动脉瓣闭锁（PA-IVS）患者，如果符合条件，可以选择手术或经导管治疗。使用慢性完全闭塞（CTO）导丝穿孔已被报道为替代射频（RF）穿孔的一种方法。我们旨在报告来自两个中心的 PA-IVS 患者使用 CTO 导丝穿孔和随后进行球囊扩张（伴或不伴动脉导管未闭支架置入）的经验。对 2014 年 3 月至 2019 年 9 月期间接受介入治疗的 PA-IVS 患者进行了回顾性研究，其中使用 CTO 导丝进行了肺动脉瓣穿孔。共确定了 26 名患者。患者的中位年龄和体重分别为 5.2 天（范围 1-21 天）和 3.1 公斤（范围 2.2-3.8 公斤）。除 1 例左房异构患者外，所有患者均为右房位。26 例患者中，22 例右心室（RV）形态为双腔，4 例为三腔。在术前，平均饱和度为 76%（范围 70-86%），同时患者接受前列腺素输注。使用 Asahi Conquest Pro 9 CTO 导丝（n=6）或 Asahi Pro 12 CTO 导丝（n=18）和/或 Asahi Miracle CTO 导丝（n=2）进行肺动脉瓣穿孔尝试。20/26（77%）名患者使用 CTO 导丝成功完成手术。我们根据亚组分析了 CTO 导丝的效率：Conquest Pro 9 在 6/6（100%）名患者中，Conquest Pro 12 在 12/18（67%）名患者中，Miracle 在 2/2（100%）名患者中。在 3 名患者使用 CTO 导丝之前，射频（RF）穿孔不成功。在这 3 名患者中，2 名患者使用 CTO 导丝成功穿孔；因此，在剩余的患者中，CTO 导丝也未能成功穿孔。在 6 名患者 CTO 导丝穿孔失败后，尝试了 3 名患者的 RF 穿孔（2 次成功，1 次失败），1 名患者转至手术治疗。19 例患者持续出现低氧血症，需要动脉导管未闭支架置入。26 名患者中有 3 名（11%）患者出现早期程序并发症。其中 2 名患者因鞘管出现血管并发症，给予肝素输注和链激酶治疗，另 1 名患者在手术过程中突然出现心动过缓并心脏骤停，对心脏复苏无反应。CTO 导丝应作为首选，或在 RF 穿孔失败时考虑用于治疗闭锁性肺动脉瓣穿孔。
