Guo Hui, Wu Zhongshi, Zhao Tianli, Yang Jinfu, Hu Shijun, Huang Can, Yang Yifeng, Xie Li
The Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University, Central South University, Changsha, China.
Front Surg. 2023 Feb 13;10:1056772. doi: 10.3389/fsurg.2023.1056772. eCollection 2023.
Right ventricular outflow tract (RVOT) stenting seems to be suggested as a promising treatment option and an alternative to modified Blalock-Taussig shunt (mBTS) in the initial palliation of patients with Fallot-type lesions in recent years. This study sought to assess the effect of RVOT stenting on the growth of the pulmonary artery (PA) in patients with Tetralogy of Fallot (TOF).
Retrospective review analyzing 5 patients with Fallot-type congenital heart disease with small pulmonary arteries who underwent palliative with RVOT stenting and 9 patients underwent modified Blalock-Taussig shunt within 9 years period. Differential left PA (LPA) and right PA (RPA) growth was measured by Cardiovascular Computed Tomography Angiography (CTA).
RVOT stenting improved arterial oxygen saturation from median of 60% (interquartile range [IQR]: 37% to 79%) to 95% (87.5% to 97.5%) ( = 0.028). The LPA diameter -score improved from -2.843 (-3.51-2.037) to -0.78 (-2.3305-0.19) ( = 0.03), the RPA diameter -score improved from median -2.843 (-3.51-2.037) to -0.477 (-1.1145-0.459) ( = 0.002), the Mc Goon ratio increased from median 1 (0.8-1.105) to 1.32 (1.25-1.98) ( = 0.017). There were no procedural complications and all 5 patients have undergone final repair in the RVOT stent group. In the mBTS group, the LPA diameter -score improved from -1.494 (-2.242-0.6135) to -0.396 (-1.488-1.228) ( = 0.15), the RPA diameter -score improved from median -1.328 (-2.036-0.838) to 0.088 (-0.486-1.223) ( = 0.007), and there were 5 patients occur different complications and 4 patients was not attained the standards of final surgical repair.
RVOT stenting, compared with mBTS, seems to better promote pulmonary artery growth, improve arterial oxygen saturations, and have less procedure complications in patients with TOF who being absolute contraindicated for primary repair due to high risks.
近年来，右心室流出道（RVOT）支架置入术似乎被视为一种有前景的治疗选择，可作为法洛四联症（TOF）型病变患者初始姑息治疗中改良布莱洛克 - 陶西格分流术（mBTS）的替代方法。本研究旨在评估RVOT支架置入术对法洛四联症（TOF）患者肺动脉（PA）生长的影响。
回顾性分析9年内5例接受RVOT支架置入术姑息治疗的肺动脉细小的法洛型先天性心脏病患者和9例接受改良布莱洛克 - 陶西格分流术的患者。通过心血管计算机断层扫描血管造影（CTA）测量左肺动脉（LPA）和右肺动脉（RPA）的差异生长情况。
RVOT支架置入术使动脉血氧饱和度从中位数60%（四分位间距[IQR]：37%至79%）提高到95%（87.5%至97.5%）（P = 0.028）。LPA直径评分从 -2.843（-3.51至 -2.037）提高到 -0.78（-2.3305至0.19）（P = 0.03），RPA直径评分从中位数 -2.843（-3.51至 -2.037）提高到 -0.477（-1.1145至0.459）（P = 0.002），麦戈恩比率从中位数1（0.8至1.105）提高到1.32（1.25至1.98）（P = 0.017）。RVOT支架组无手术并发症，所有5例患者均接受了最终修复。在mBTS组中，LPA直径评分从 -1.494（-2.242至 -0.6135）提高到 -0.396（-1.488至1.228）（P = 0.15），RPA直径评分从中位数 -1.328（-2.036至 -0.838）提高到0.088（-0.486至1.223）（P = 0.007），有5例患者出现不同并发症，4例患者未达到最终手术修复标准。
与mBTS相比，RVOT支架置入术似乎能更好地促进肺动脉生长，提高动脉血氧饱和度，且在因高风险而绝对禁忌一期修复的TOF患者中手术并发症更少。
