Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.
Department of Pediatrics, Faculty of Medicine, Benha University, Banha, Egypt.
Catheter Cardiovasc Interv. 2022 Jul;100(1):105-112. doi: 10.1002/ccd.30223. Epub 2022 May 11.
This study addresses the outcome of right ventricle outflow tract (RVOT) stenting in Tetralogy of Fallot (ToF) with anomalous coronaries crossing the RVOT. RVOT stenting in ToF patients has emerged as an alternative to Blalock Taussig shunting. This is a single center study of patients who underwent RVOT stenting for symptomatic ToF at Birmingham Children's Hospital between 2005 and 2020. A total of 122 patients underwent RVOT stenting as initial palliation over a 15-year period, 10 patients had anomalous coronaries crossing the RVOT (study group) and 112 not (comparative group). Median age of the study group was 72.5 days (interquartile range [IQR]: 28-103) with a weight of 4.7 kg (IQR: 3.5-4.9). No significant differences were found between the two groups regarding the patients' weights and ages, procedure and screening times, or hospital stay. Four had valve sparing stenting. Oxygen saturations increased from a median of 75.5% (IQR: 70-82) to 94.5% (IQR: 90-95), p < 0.002. Postprocedure median hospital stay was 3 days (IQR: 2-6). Six patients underwent interstage catheterization reintervention and one needed early surgical palliation due to stent suboptimal position. Complete repair could be delayed for a median of 11.1 months (IQR: 5.6-19.2). At surgical repair, the patients had a median age of 12.3 months (IQR: 7.5-25.6) and weight of 7.7 kg (IQR: 6.8-10.8). There were no deaths. RVOT stenting in ToF with anomalous coronaries is safe and effective. Dilatable stents should be used when two-stage delayed conduit repair is the default approach.
这项研究探讨了在伴有异常冠状动脉穿过右心室流出道（RVOT）的法洛四联症（ToF）中 RVOT 支架置入的结果。RVOT 支架置入术已成为 Blalock-Taussig 分流术的替代方法。这是一项单中心研究，研究对象为 2005 年至 2020 年期间在伯明翰儿童医院因症状性 ToF 接受 RVOT 支架置入的患者。在 15 年期间，共有 122 名患者接受 RVOT 支架置入作为初始姑息治疗，其中 10 名患者存在异常冠状动脉穿过 RVOT（研究组），112 名患者没有（对照组）。研究组的中位年龄为 72.5 天（四分位距 [IQR]：28-103），体重为 4.7kg（IQR：3.5-4.9）。两组患者的体重和年龄、手术和筛查时间或住院时间无显著差异。有 4 例进行了瓣膜保留支架置入。氧饱和度从中位数 75.5%（IQR：70-82）增加到 94.5%（IQR：90-95），p<0.002。术后中位住院时间为 3 天（IQR：2-6）。6 名患者进行了中间导管再介入治疗，1 名患者因支架位置不理想而需要早期手术姑息治疗。中位完全修复时间可延迟 11.1 个月（IQR：5.6-19.2）。在手术修复时，患者的中位年龄为 12.3 个月（IQR：7.5-25.6），体重为 7.7kg（IQR：6.8-10.8）。无死亡病例。在伴有异常冠状动脉的 ToF 中进行 RVOT 支架置入是安全有效的。当两阶段延迟导管修复是默认方法时，应使用可扩张支架。
