Shahanavaz Shabana, Qureshi Athar M, Petit Christopher J, Goldstein Bryan H, Glatz Andrew C, Bauser-Heaton Holly, McCracken Courtney E, Kelleman Michael S, Nicholson George T, Zampi Jeffrey D, Pettus Joelle, Meadows Jeffery, Hock Kristal M, Law Mark A
Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, Missouri.
Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
J Soc Cardiovasc Angiogr Interv. 2023 Jul 5;2(6Part A):101062. doi: 10.1016/j.jscai.2023.101062. eCollection 2023 Nov-Dec.
Complete repair (CR) can be delayed in neonates with symptomatic tetralogy of Fallot (sTOF) using surgical or transcatheter palliation to relieve cyanosis. Balloon pulmonary valvuloplasty (BPV) is an established treatment for pulmonary valve stenosis; however, its effectiveness in palliating neonates with sTOF has not been well investigated.
A retrospective chart review between 2005 and 2017 on neonates with sTOF who underwent initial BPV from 9 participating centers of the Congenital Cardiac Research Collaborative was performed. Primary outcome was CR at >30 days after BPV without interval reintervention (RI).
In total, 47 neonates with sTOF underwent BPV, of whom 27 (57%) underwent CR at >30 days after BPV without RI. The median time to CR was 151 days (106-210). RI before CR occurred in 17 patients (36%): surgical shunt (n = 7), outflow tract stenting (n = 6), patent ductus arteriosus stenting (n = 2), and surgical outflow patch (n = 2). Valve-sparing repair at CR was performed in 6 patients (13%) after initial BPV. RI or CR ≤30 days from BPV was associated with smaller infundibular diastolic diameter ( = .004). An infundibular diastolic diameter of <3.4 mm demonstrated 75% sensitivity and 67% specificity to predict early CR or RI.
BPV can be an effective palliative therapy in select neonates with sTOF to delay CR. A smaller diastolic infundibulum diameter is a predictor of RI or early CR, and valve-sparing repair is uncommon, making patient selection and alternative palliative methods key when considering BPV palliation in neonates with sTOF.
对于有症状的法洛四联症（sTOF）新生儿，可采用手术或经导管姑息治疗缓解青紫，从而延迟进行完全修复（CR）。球囊肺动脉瓣成形术（BPV）是治疗肺动脉瓣狭窄的既定方法；然而，其对sTOF新生儿的姑息治疗效果尚未得到充分研究。
对2005年至2017年间，来自先天性心脏病研究协作组9个参与中心的接受初次BPV的sTOF新生儿进行回顾性图表审查。主要结局是BPV后>30天且无间隔再次干预（RI）的CR。
共有47例sTOF新生儿接受了BPV，其中27例（57%）在BPV后>30天且无RI的情况下接受了CR。CR的中位时间为151天（106 - 210天）。17例患者（36%）在CR前发生了RI：手术分流（n = 7）、流出道支架置入（n = 6）、动脉导管未闭支架置入（n = 2）和手术流出道补片（n = 2）。6例患者（13%）在初次BPV后CR时进行了保留瓣膜修复。BPV后≤30天的RI或CR与较小的漏斗部舒张直径相关（P = 0.004）。漏斗部舒张直径<3.4 mm预测早期CR或RI的敏感性为75%，特异性为67%。
BPV对于部分sTOF新生儿可能是一种有效的姑息治疗方法，可延迟CR。较小的漏斗部舒张直径是RI或早期CR的预测指标，且保留瓣膜修复并不常见，因此在考虑对sTOF新生儿进行BPV姑息治疗时，患者选择和替代姑息方法是关键。
