Sasikumar Navaneetha, Alawani Sujata, Sudhakar Abish, Kumar Raman Krishna
Department of Pediatric Cardiology, Amrita Institute of Medical Sciences, Kochi, Kerala, 682041, India.
Pediatr Cardiol. 2024 Dec;45(8):1823-1829. doi: 10.1007/s00246-023-03288-6. Epub 2023 Sep 11.
The optimal approach for supravalvar right ventricular outflow tract obstruction(RVOTO) after arterial switch operation(ASO) is unclear. The results of percutaneous balloon dilatation have been variable. We report the results of simultaneous double balloon dilation for RVOTO after ASO. Sixteen patients (1.3(0.7-3.8) years; 9.8(8.1-15.1) kgs underwent the procedure at 14(8-44.5) months after ASO. Salient technical features included placement of balloons over stiff guide-wires positioned in both branch pulmonary arteries to enable dilation of the distal-most main pulmonary artery (MPA) with high inflation pressures (~ 12-14 atmospheres) and short inflation-deflation cycles. Effective balloon size was based on the PA annulus or MPA distal to the narrowing. The final balloon: narrowest segment diameter ratio was 2.7. Following dilation, the right ventricle to systemic systolic pressure ratio decreased from 0.9 ± 0.18 to 0.52 ± 0.16 (p < 0.001) and mean RVOT gradient from 78 ± 18 to 34 ± 13.9 mmHg (p < 0.001). Narrowest diameter improved from 5.4 ± 2.2 to 9.2 ± 2.2 mm. There were no major complications. Two patients with inadequate relief (final RV-systemic ratios: 1.03 and 0.7) were referred for surgery. At median follow up of 9 months, IQR 7-22, range 5-73, others are free of re interventions with median RVOT gradient of 42, IQR 27-49, range 21-55 mmHg. The immediate and short-term follow up results of double balloon dilatation for supravalvar RVOTO is encouraging and may avoid the need for repeat surgery in the majority of patients. Further follow up is needed to determine the long-term durability of the results.
动脉调转术（ASO）后，针对瓣上型右心室流出道梗阻（RVOTO）的最佳治疗方法尚不清楚。经皮球囊扩张术的效果不一。我们报告了ASO后针对RVOTO进行同步双球囊扩张术的结果。16例患者（年龄1.3（0.7 - 3.8）岁；体重9.8（8.1 - 15.1）千克）在ASO后14（8 - 44.5）个月接受了该手术。显著的技术特点包括将球囊置于位于双侧肺分支动脉的硬导丝上，以便在高充盈压力（约12 - 14个大气压）和短充放气周期下扩张最远端的主肺动脉（MPA）。有效球囊尺寸基于PA瓣环或狭窄远端的MPA。最终球囊与最窄段直径之比为2.7。扩张后，右心室与体循环收缩压之比从0.9±0.18降至0.52±0.16（p＜0.001），平均RVOT梯度从78±18降至34±13.9 mmHg（p＜0.001）。最窄直径从5.4±2.2改善至9.2±2.2 mm。无重大并发症。2例缓解不充分的患者（最终RV - 体循环比值：1.03和0.7）被转诊接受手术。在9个月的中位随访期，四分位间距7 - 22，范围5 - 73，其他患者无需再次干预，RVOT梯度中位数为42，四分位间距27 - 49，范围21 - 55 mmHg。瓣上型RVOTO双球囊扩张术的即刻和短期随访结果令人鼓舞，可能避免大多数患者再次手术的需要。需要进一步随访以确定结果的长期持久性。
