经导管主肺动脉间隔缺损封堵术治疗合并依赖导管的肺血流、垂直及迂曲的动脉导管未闭患者的新方法
A Better Way for Ductal Stenting in Patients with Duct-Dependent Pulmonary Flow and Vertical and Tortuous Patent Ductus Arteriosus.
机构信息
Department of Pediatric Cardiology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey.
Department of Pediatric Cardiology, Faculty of Medicine, Fırat University, Elazığ, Turkey.
出版信息
Anatol J Cardiol. 2022 Dec;26(12):872-879. doi: 10.5152/AnatolJCardiol.2022.1866.
BACKGROUND
In this study, we aimed to compare the femoral route and the carotid artery route in terms of procedural success of ductal stent implantation in patients with ductdependent pulmonary blood flow.
METHODS
The study included 51 patients with duct-dependent pulmonary circulation who underwent ductal stent implantation upon their admission to our clinic between July 2017 and March 2021. In total, 23 patients (group I) underwent ductal stent implantation via the femoral route, while the remaining 28 (group II) underwent the procedure via the carotid artery. The groups were compared in terms of procedural success, time, post-procedural blood pH, lactate levels, and complications.
RESULTS
Duct morphology was observed in group 1 as follows: type 1 in 12 patients, type 3 in 8, type 2 in 2, and type 6 in 1 patient. In group 2, 26 patients had type 3, 1 had type 2, and 1 had type 6. The tortuosity index of the patients in group 1 was 1 in 8 patients, 2 in 8 patients, and 3 in 7 patients, while in group 2, it was 1 in 5 patients, 2 in 15 patients, and 3 in 8 patients. The success rate was 69.6% (16/26) in group I and 93.5% (29/31) in group II (P=.030). The cumulative success rate was 88.2% (45/51). The procedural durations were 78.2 ± 34.1 and 52.1 ± 22.0 minutes in group I and group II, respectively (P=.002). The mean blood pH values upon the completion of the procedure were 7.26 ± 0.1 and 7.33 ± 0.0 in group I and group II, respectively (P=.038). The mean post-procedural lactate levels were 2.8 mmol/L and 2.3 mmol/L in group I and group II, respectively (P=.038). The 2 groups did not show any differences in terms of procedural complications.
CONCLUSION
The carotid artery route can be preferred, especially in vertical and tortuous ductus arteriosus, as it is associated with a high success rate and a short procedural time, as well as a better metabolic condition after the procedure.
背景
本研究旨在比较经股动脉途径和颈动脉途径在经导管肺动脉瓣支架植入术治疗依赖导管的肺血流患者中的应用效果。
方法
本研究纳入 2017 年 7 月至 2021 年 3 月在我院接受经导管肺动脉瓣支架植入术治疗的 51 例依赖导管的肺循环患者。其中 23 例（I 组）经股动脉途径进行肺动脉瓣支架植入术，28 例（II 组）经颈动脉途径进行肺动脉瓣支架植入术。比较两组患者的手术成功率、手术时间、术后血 pH 值、血乳酸水平及并发症。
结果
I 组患者的导管形态如下：12 例为 1 型，8 例为 3 型，2 例为 2 型，1 例为 6 型。II 组患者中，26 例为 3 型，1 例为 2 型，1 例为 6 型。I 组患者的导管迂曲指数为 8 例 1 分，8 例 2 分，7 例 3 分；II 组患者的导管迂曲指数为 5 例 1 分，15 例 2 分，8 例 3 分。I 组手术成功率为 69.6%（16/26），II 组为 93.5%（29/31）（P=.030）。累积成功率为 88.2%（45/51）。I 组和 II 组的手术时间分别为 78.2±34.1 分钟和 52.1±22.0 分钟（P=.002）。I 组和 II 组患者术后血 pH 值分别为 7.26±0.1 和 7.33±0.0（P=.038）。I 组和 II 组患者术后血乳酸水平分别为 2.8mmol/L 和 2.3mmol/L（P=.038）。两组患者的手术并发症发生率无统计学差异。
结论
在垂直且迂曲的动脉导管中，颈动脉途径可优先选择，因为它与较高的成功率、较短的手术时间以及术后更好的代谢状态相关。
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