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支架作为大动脉转位延迟表现患者动脉调转术的过渡手段

Stents as Bridge to Arterial Switch Operation for D-Transposition of Great Arteries Late Presenter.

作者信息

Liman Novita Gemalasari, Prakoso Radityo

机构信息

Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Indonesian Heart Association, Jakarta 11420, Indonesia.

出版信息

Int J Angiol. 2021 Mar 11;31(1):70-74. doi: 10.1055/s-0041-1726129. eCollection 2022 Mar.

Abstract

We report a 5-month-old infant with dextro-transposition of great arteries (D-TGA) with intact ventricular septum (IVS) who had low left ventricular mass index, small patent ductus arteriosus (PDA), and stretched patent foramen ovale. The patient had respiratory failure due to pneumonia. The surgical intervention was considered very high risk. Thus, the patient underwent PDA stenting with balloon predilation technique followed by atrial septal stenting with false impression of dislodgement-"pseudo-dislodgement" because of inadvertent retraction of patent foramen ovale that was confirmed by transthoracic echocardiography guidance. After the procedure, the left ventricular mass index improved and patient was planned for arterial switch operation. The combined approach of PDA and atrial septal stenting may provide potential nonsurgical method of ventricular preparation for D-TGA/IVS late presenter, acting as a bridge to arterial switch operation especially those living in remote areas.

摘要

我们报告了一名5个月大的患有大动脉右位转位(D-TGA)且室间隔完整(IVS)的婴儿,其左心室质量指数较低,动脉导管未闭(PDA)较小,卵圆孔未闭扩大。该患者因肺炎出现呼吸衰竭。手术干预被认为风险极高。因此,该患者先采用球囊预扩张技术进行PDA支架置入术,随后在经胸超声心动图引导下,因卵圆孔未闭意外回缩导致有移位假象——“假性移位”而进行房间隔支架置入术。术后,左心室质量指数有所改善,患者计划接受动脉调转手术。PDA和房间隔支架置入术的联合方法可能为D-TGA/IVS晚期患者提供一种潜在的非手术心室准备方法,作为通向动脉调转手术的桥梁,尤其是对于那些生活在偏远地区的患者。

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