Division of Cardiology, The Children's Hospital of Philadelphia and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, PA, USA.
Center for Pediatric Clinical Effectiveness, The Children's Hospital of Philadelphia, PA, USA.
World J Pediatr Congenit Heart Surg. 2021 Sep;12(5):635-642. doi: 10.1177/21501351211033238.
Balloon and stent angioplasty of the pulmonary arteries (PAs) are frequently performed following superior cavopulmonary connection (SCPC), not only to normalize the caliber of the affected PA but also in hopes of maximizing downstream growth over time. There are limited data on the impact on subsequent PA growth prior to total cavopulmonary connection (TCPC).
A single-center, retrospective cohort study was performed on children who underwent transcatheter (TC) PA intervention following SCPC between January 1, 2010, and December 31, 2018. Growth of treated and contralateral PAs was measured at the lobar bifurcation (distal branch PA [DBPA]) and in the proximal lower lobe (lower lobe branch [LLB]) on serial angiograms. Growth rate was evaluated using a mixed-effect model clustered by individual patient with an interaction term for treated PA and time to evaluate for differential growth rates between treated and contralateral PAs.
Thirty-five patients underwent TC PA intervention following SCPC, at a median of 70 days (interquartile range: 19-297 days) postoperatively. Significant growth was seen at both DBPA and LLB for raw (0.8 mm/year, 95% CI: 0.6-1.0, < .001 for both) and body surface area (BSA) adjusted measures (8.4mm/m/year, 95% CI: 5.6-11.2, < .001; 7.9 mm/m/year, 95% CI: 5.5-10.2, < .001). The growth rate of the treated vessel was not significantly different from that of the contralateral vessel at the DBPA or LLB positions for raw ( = .71, .70) or BSA-adjusted measurements ( = .86, .64).
Transcatheter PA intervention was associated with normal distal PA growth rate relative to the untreated side.
在完成腔静脉肺动脉连接术（SCPC）后，常对肺动（PA）进行球囊和支架血管成形术，不仅使受影响的 PA 口径正常化，而且希望随着时间的推移，最大限度地促进下游生长。在进行完全腔静脉肺动脉连接术（TCPC）之前，关于 PA 生长的影响的数据有限。
对 2010 年 1 月 1 日至 2018 年 12 月 31 日期间接受经导管（TC）PA 介入治疗的 SCPC 术后儿童进行了一项单中心回顾性队列研究。在系列血管造影上，在叶分叉处（远端分支 PA [DBPA]）和近端下叶（下叶分支 [LLB]）测量治疗和对侧 PA 的生长情况。使用混合效应模型评估增长率，该模型通过个体患者进行聚类，并设置治疗 PA 与时间的交互项，以评估治疗 PA 和对侧 PA 之间的生长速率差异。
35 例患者在 SCPC 术后 70 天（中位数，19-297 天）内行 TC PA 介入治疗。在 DBPA 和 LLB 处均可见明显生长，无论是原始数据（0.8mm/年，95%CI：0.6-1.0，均<0.001）还是体表面积（BSA）校正后的测量值（8.4mm/m/年，95%CI：5.6-11.2，均<0.001；7.9mm/m/年，95%CI：5.5-10.2，均<0.001）。在 DBPA 或 LLB 位置，治疗血管的生长速率与未治疗侧相比，无论是原始数据（ =.71，.70）还是 BSA 校正后的测量值（ =.86，.64），均无显著差异。
与未治疗侧相比，经导管 PA 介入治疗与正常的远端 PA 生长速率相关。
