右心室流出道支架置入术是有症状的法洛四联症婴儿根治性修复的安全有效桥梁。
Right Ventricular Outflow Tract Stenting is a Safe and Effective Bridge to Definitive Repair in Symptomatic Infants With Tetralogy of Fallot.
机构信息
Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Heart Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia.
出版信息
Heart Lung Circ. 2023 May;32(5):638-644. doi: 10.1016/j.hlc.2023.02.010. Epub 2023 Mar 22.
INTRODUCTION
Right ventricular outflow tract (RVOT) stent angioplasty is a palliative procedure for neonates and infants with symptomatic tetralogy of Fallot prior to surgical repair. We review our institutional outcomes of RVOT stenting.
METHODS
Retrospective review of all infants with tetralogy of Fallot under 3 months of age who underwent primary native RVOT stent angioplasty at The Children's Hospital at Westmead, Sydney, Australia between January 2010 and December 2020. Demographics and echocardiographic pulmonary artery dimensions were collected pre-stent angioplasty and prior to surgical repair.
RESULTS
Twenty (20) infants underwent primary RVOT stenting. Median age at stent was 14 days (interquartile range [IQR] 7-32) and median weight 2.7 kg (IQR 2.1-3.4). Three patients underwent hybrid per-ventricular procedures. Indication for RVOT stenting was recurrent hyper-cyanotic spells in 12 (60%) and duct-dependent pulmonary blood flow in 8 (40%). Saturations increased from a median of 80% (IQR 75-85) to 91% (IQR 90-95) post procedure (P<0.001). A single major complication occurred: transient complete atrioventricular dissociation requiring isoprenaline infusion for <24 hours. Twelve (12, 60%) required catheter re-intervention prior to definitive repair for further augmentation of pulmonary blood flow. There were two non-cardiac deaths distant from the stent procedure, but prior to surgical repair. Median right and left pulmonary artery Z-scores increased respectively from -2.06 (IQR -2.99 to -0.17) and -1.2 (IQR -2.59 to -0.14) prior to RVOT stent, to -0.74 (IQR [-1.21 to 0.26], P=0.01) and 0.06 (IQR [-1.87 to 1.15], P=0.006) by the time of definitive repair. Eighteen (18) patients achieved definitive repair at a median age of 6.1 months (IQR 4.7-7.3). Palliation with more than one RVOT stent was associated with an increased duration of cardiac bypass (P=0.035) and cross-clamp (P=0.044) time at definitive repair.
CONCLUSIONS
In symptomatic neonates and infants with tetralogy of Fallot at high-risk of peri-operative complications, RVOT stent angioplasty can safely and effectively augment pulmonary blood flow prior to definitive repair.
简介
右心室流出道（RVOT）支架血管成形术是一种姑息性手术，适用于有症状的法洛四联症新生儿和婴儿，在手术修复之前进行。我们回顾了我们机构在 RVOT 支架置入方面的结果。
方法
回顾性分析 2010 年 1 月至 2020 年 12 月期间，在澳大利亚西悉尼儿童医院接受原发性 RVOT 支架血管成形术的所有年龄小于 3 个月的法洛四联症婴儿。收集支架置入前的人口统计学和超声心动图肺动脉尺寸。
结果
20 名婴儿接受了原发性 RVOT 支架置入。支架置入时的中位年龄为 14 天（四分位距 [IQR] 7-32），体重中位数为 2.7 公斤（IQR 2.1-3.4）。3 名患者接受了经心室的杂交手术。RVOT 支架置入的指征为复发性高氰血症发作 12 例（60%）和依赖导管的肺血流量 8 例（40%）。饱和度从术后中位数 80%（IQR 75-85）增加至 91%（IQR 90-95）（P<0.001）。仅发生 1 例严重并发症：短暂完全性房室传导阻滞，需要异丙肾上腺素输注<24 小时。12 例（12，60%）在确定性修复前需要再次进行导管介入以进一步增加肺血流量。有 2 例非心脏死亡，与支架手术距离较远，但在手术修复之前。右肺动脉和左肺动脉 Z 评分中位数分别从 RVOT 支架置入前的-2.06（IQR -2.99 至-0.17）和-1.2（IQR -2.59 至-0.14）增加至-0.74（IQR [-1.21 至 0.26]，P=0.01）和 0.06（IQR [-1.87 至 1.15]，P=0.006），直至确定性修复时。18 例（18）患者在中位年龄 6.1 个月（IQR 4.7-7.3）时进行了确定性修复。RVOT 支架置入超过 1 次与确定性修复时的体外循环（P=0.035）和阻断时间（P=0.044）延长相关。
结论
对于有症状的法洛四联症新生儿和婴儿，存在围手术期并发症的高危风险，RVOT 支架血管成形术可在确定性修复前安全有效地增加肺血流量。
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