Jiao X T, Zhao L Q, Shen J, Wu Y R, Zhao P J, Sun K, Chen S
Department of Pediatric Cardiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200292, China.
Zhonghua Er Ke Za Zhi. 2023 Feb 2;61(2):136-140. doi: 10.3760/cma.j.cn112140-20221104-00934.
To summarize the outcomes of different types of pulmonary atresia in neonates treated by ductus arteriosus stenting. This study was a retrospective cohort study. A total of 19 neonates who had pulmonary atresia treated by ductus arteriosus stenting in Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from April 2014 to June 2021 were included. They were divided into the intact ventricular septum (PA-IVS) group and the ventricular septal defect (PA-VSD) group. Ductus arteriosus stents were implanted by different approaches. These children were followed up regularly at the 1, 3, 6, and 12 months after the surgery and annually since then to evaluate the outcome. Independent sample -test was used for the statistical analysis. There were 12 children in PA-IVS group and 7 in PA-VSD group. All of them were full term in fants. The gestational age of the PA-IVS group and the PA-VSD group was (38.8±1.1) and (37.7±1.8) weeks, the birth weights were (3.2±0.4) and (3.4±1.1) kg, and the age at operation was (10±9) and (12±7) days, respectively, without significant difference (all >0.05). Among the 12 children with PA-IVS, 9 had stents successfully implanted through the femoral artery and 3 through the femoral vein. Of the 7 children with PA-VSD, 2 had the stents successfully implanted via the femoral artery and 2 failed, and the remaining 3 had stents successfully implanted via the left carotid artery. There was no postoperative thromboembolism, arteriovenous fistula, pseudoaneurysm or other vascular complications. Five children with PA-VSD who had successful operations were followed up at 6 months of age. They all had the operation for pulmonary atresia, repair of the ventricular septal defect, removal of arterial duct stents, and ligation of the arterial duct. All children survived without any stent displacement or stenosis and biventricular circulation was achieved during the follow-up. Ductus arteriosous stenting can be the first-stage treatment for children with PA-IVS and PA-VSD. In addition to the traditional femoral vein and femoral artery approach, the carotid artery can be used as a route for stent placement.
总结经动脉导管支架置入术治疗的新生儿不同类型肺动脉闭锁的治疗效果。本研究为回顾性队列研究。纳入2014年4月至2021年6月在上海交通大学医学院附属新华医院接受动脉导管支架置入术治疗的19例肺动脉闭锁新生儿。将其分为室间隔完整型（PA-IVS）组和室间隔缺损型（PA-VSD）组。采用不同方法植入动脉导管支架。术后1、3、6和12个月定期对这些患儿进行随访，此后每年随访一次以评估治疗效果。采用独立样本t检验进行统计分析。PA-IVS组12例患儿，PA-VSD组7例患儿。所有患儿均为足月儿。PA-IVS组和PA-VSD组的胎龄分别为（38.8±1.1）周和（37.7±1.8）周，出生体重分别为（3.2±0.4）kg和（3.4±1.1）kg，手术年龄分别为（10±9）天和（12±7）天，差异均无统计学意义（均>0.05）。12例PA-IVS患儿中，9例经股动脉成功植入支架，3例经股静脉成功植入支架。7例PA-VSD患儿中，2例经股动脉成功植入支架，2例失败，其余3例经左颈动脉成功植入支架。术后无血栓栓塞、动静脉瘘、假性动脉瘤或其他血管并发症。5例手术成功的PA-VSD患儿在6个月时进行随访。他们均接受了肺动脉闭锁矫治术、室间隔缺损修补术、动脉导管支架取出术及动脉导管结扎术。所有患儿均存活，随访期间无支架移位或狭窄，实现了双心室循环。动脉导管支架置入术可作为PA-IVS和PA-VSD患儿的一期治疗方法。除传统的股静脉和股动脉途径外，颈动脉可作为支架置入的途径。
