Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Cardiac Center, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
Heart Vessels. 2022 May;37(5):875-883. doi: 10.1007/s00380-021-01978-w. Epub 2021 Oct 29.
Transcatheter ductus arteriosus stenting (DS) is emerging as an alternative method to modified Blalock-Taussig shunt (MBTS) in providing pulmonary blood flow in cyanotic congenital heart disease (CCHD) with duct-dependent pulmonary circulation.
To evaluate post-procedural outcomes and survival between patients undergoing DS and MBTS.
All infants ≤ 60 days of age having CCHD with diminished pulmonary blood flow who underwent palliative procedure either with MBTS or DS at King Chulalongkorn Memorial Hospital during January 1st, 2013 and December 31th, 2017 were retrospectively reviewed.
98 patients were included; 34 patients underwent a transcatheter DS and 64 patients underwent MBTS. There was no significant difference in post-procedural outcomes and overall mortality rate between two groups (17.6% in MBTS group and 6.1% in DS group, p = 0.09). Single ventricle morphology was the major risk factor associated with increased mortality compared with biventricular morphology (aHR 3.9, 95% CI 1.49-10.2, p = 0.01). There was similar number of early and pre-repair additional interventions focusing on MBTS/DS patency between two groups. The MBTS group had a greater number of early interventions on PA branch stenosis related to baseline diagnosis. Risk factors associated with additional intervention were pre-existing pulmonary branch stenosis (aHR 2.54, 95% CI 1.3-4.97, p = 0.006) and body weight less than 2.5 kg (aHR 3.33, 95% CI 1.57-7.08, p = 0.003). Having pulmonic valve perforation or balloon pulmonary valvuloplasty to promote antegrade pulmonary blood flow could result in a lower number of additional interventions required before definitive repair.
Duct stenting is a feasible and safe alternative to MBTS in cyanotic infants with duct-dependent pulmonary circulation. However, mortality rate was significantly higher in patients with single ventricle that required careful follow-up after procedure.
经导管动脉导管未闭支架置入术（DS）作为一种替代改良 Blalock-Taussig 分流术（MBTS）的方法，在伴有导管依赖性肺循环的发绀型先天性心脏病（CCHD）中提供肺血流量。
评估经导管动脉导管未闭支架置入术（DS）和改良 Blalock-Taussig 分流术（MBTS）患者的术后结果和生存率。
回顾性分析 2013 年 1 月 1 日至 2017 年 12 月 31 日期间，在朱拉隆功国王纪念医院接受姑息性治疗的伴有肺血流量减少的 CCHD 且≤60 日龄婴儿的临床资料，这些婴儿行 MBTS 或 DS 治疗。
共纳入 98 例患者，34 例行 DS，64 例行 MBTS。两组患者术后结果和总体死亡率无显著差异（MBTS 组为 17.6%，DS 组为 6.1%，p=0.09）。与双心室形态相比，单心室形态是与死亡率增加相关的主要危险因素（aHR 3.9，95%CI 1.49-10.2，p=0.01）。两组患者 MBTS/DS 通畅性相关的早期和术前修复附加干预的数量相似。MBTS 组与基线诊断相关的 PA 分支狭窄的早期干预更多。附加干预的相关危险因素是术前存在肺分支狭窄（aHR 2.54，95%CI 1.3-4.97，p=0.006）和体重小于 2.5kg（aHR 3.33，95%CI 1.57-7.08，p=0.003）。行肺动脉瓣穿孔或球囊肺动脉瓣成形术以促进肺前向血流可减少术前修复所需的附加干预次数。
在伴有导管依赖性肺循环的发绀型婴儿中，DS 是 MBTS 的一种可行且安全的替代方法。然而，需要行单心室修复的患者死亡率显著更高，需要术后密切随访。
