El-Saiedi Sonia A, Attia Wael A, Abd El-Rahim Ashraf, Hanna Baher M
Department of Pediatrics, Faculty of Medicine, Cairo University, Egypt.
Department of Anesthesia, Faculty of Medicine, Cairo University, Egypt.
J Saudi Heart Assoc. 2022 Apr 11;34(1):41-52. doi: 10.37616/2212-5043.1292. eCollection 2022.
INTRODUCTION & AIM OF WORK: Transcatheter treatment for critical pulmonary stenosis and membranous pulmonary atresia has become the gold standard of care in many centers. We aimed at evaluating the predictors of outcome in interventions for treatment of duct-dependent right ventricular outflow tract obstruction with intact interventricular septum.
SUBJECTS & METHODS: 68 cases with pulmonary atresia with intact interventricular septum (PA/IVS) and 50 cases with critical pulmonary stenosis (CPS), all younger than 3 months of age, were operated during the period of 10 years; excluding patients with tricuspid valve annulus Z-score smaller than -4, evidence of right ventricular-dependent coronary circulation or additional malformations.
Age, weight, body surface area as well as tricuspid & pulmonary valve Z-scores were significantly less in PA/IVS; right ventricular pressure was similar in both groups however procedural success and survival to hospital discharge was higher in the CPS group. Lower age, weight and body surface area were associated with procedural failure. Weight was the only predictor of procedural success; while weight and lower post-procedural right ventricular pressure were independent predictors for survival to hospital discharge. Post-procedural right ventricular pressure and length of stay were less in the CPS group. tricuspid and pulmonary valve annulus Z-scores were the only independent predictors of the post-procedural milrinone duration in PA/IVS.
We advocate for the use of larger balloon/pulmonary annulus ratio, to achieve a lower right ventricular pressure not fearing excessive pulmonary regurgitation that might be beneficial for right ventricular growth; and for the combination with ductal stenting in borderline or bipartite right ventricles.
经导管治疗重度肺动脉狭窄和膜性肺动脉闭锁已成为许多中心的标准治疗方法。我们旨在评估室间隔完整的导管依赖性右心室流出道梗阻干预治疗的预后预测因素。
在10年期间为68例室间隔完整的肺动脉闭锁（PA/IVS）患者和50例重度肺动脉狭窄（CPS）患者进行了手术，所有患者年龄均小于3个月；排除三尖瓣环Z值小于-4、存在右心室依赖性冠状动脉循环或其他畸形的患者。
PA/IVS患者的年龄、体重、体表面积以及三尖瓣和肺动脉瓣Z值显著更低；两组的右心室压力相似，但CPS组的手术成功率和出院存活率更高。年龄较小、体重较轻和体表面积较小与手术失败相关。体重是手术成功的唯一预测因素；而体重和术后较低的右心室压力是出院存活的独立预测因素。CPS组的术后右心室压力和住院时间更短。三尖瓣和肺动脉瓣环Z值是PA/IVS术后米力农使用时长的唯一独立预测因素。
我们主张使用更大的球囊/肺动脉瓣环比值，以实现更低的右心室压力，不必担心可能有利于右心室生长的过度肺反流；对于临界或双叶右心室，主张联合使用导管支架置入术。
