Pediatric Department, Division of Pediatric Cardiology, Cairo University, Giza, Egypt.
Radiodiagnostics Department, Cairo University, Giza, Egypt.
J Interv Cardiol. 2023 Feb 1;2023:9709227. doi: 10.1155/2023/9709227. eCollection 2023.
Pulmonary atresia with intact ventricular septum (PA/IVS) can be treated by catheter-based interventions and complemented by various surgical procedures. We aim to determine a long-term treatment strategy to enable patients to be surgery free, depending solely on percutaneous interventions.
We selected five patients from among a cohort of patients with PA/IVS treated at birth with radiofrequency perforation and dilatation of the pulmonary valve. Patients had reached a pulmonary valve annulus of 20 mm or larger on their biannual echocardiographic follow-up, with right ventricular dilatation. The findings, together with the right ventricular outflow tract and pulmonary arterial tree, were confirmed by multislice computerised tomography. Based on the angiographic size of the pulmonary valve annulus, all patients were successfully implanted with either Melody® or Edwards® pulmonary valves percutaneously, regardless of their small weights and ages. No complications were encountered.
We managed to stretch the age and weight limitations for performing percutaneous pulmonary valve implantation (PPVI): interventions were attempted whenever a pulmonary annulus size of >20 mm was reached, which was rationalised by the prevention of progressive right ventricular outflow tract dilatation and accommodating valves between 24 and 26 mm, which is enough to sustain a normal pulmonary flow in adulthood.
肺动脉瓣闭锁伴完整室间隔（PA/IVS）可通过基于导管的介入治疗，并辅以各种手术来治疗。我们旨在确定一种长期的治疗策略，使患者无需手术，仅依赖经皮介入治疗。
我们从出生时接受射频穿孔和肺动脉瓣扩张治疗的 PA/IVS 患者队列中选择了 5 名患者。这些患者在每半年的超声心动图随访中，肺动脉瓣环达到 20mm 或更大，并伴有右心室扩张。这些发现与右心室流出道和肺动脉树一起，通过多层计算机断层扫描得到证实。基于肺动脉瓣环的血管造影大小，所有患者均成功地经皮植入了 Melody®或 Edwards®肺动脉瓣，无论其体重和年龄如何。没有发生并发症。
我们成功地扩展了经皮肺动脉瓣植入术（PPVI）的年龄和体重限制：只要达到肺动脉瓣环>20mm 的大小，就会尝试进行介入治疗，这通过预防右心室流出道进行性扩张和在 24 至 26mm 之间容纳瓣膜来合理化，这足以维持成年后的正常肺血流量。
