Grozdanov Dimitrij, Piber Nicole, Borgmann Kristina, Schaeffer Thibault, Osawa Takuya, Palm Jonas, Niedermaier Carolin, Heinisch Paul Philipp, Georgiev Stanimir, Hager Alfred, Ewert Peter, Hörer Jürgen, Ono Masamichi
Department of Congenital and Pediatric Heart Surgery, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany; Division of Congenital and Pediatric Heart Surgery, University Hospital of Munich, Ludwig-Maximilians-Universität, Munich, Germany; Europäisches Kinderherzzentrum München, Munich, Germany.
Department of Cardiovascular Surgery, German Heart Center Munich, University Hospital of Technische Universität München, Munich, Germany.
J Thorac Cardiovasc Surg. 2025 May;169(5):1317-1326.e3. doi: 10.1016/j.jtcvs.2024.09.047. Epub 2024 Oct 3.
We aimed to compare the pulmonary artery (PA) growth between infants with univentricular hearts who underwent a ductus stenting (DS) and those who received a systemic to pulmonary shunt (SPS) as an initial palliation.
All infants with ductal-dependent pulmonary blood flow who underwent initial palliation with either a DS or SPS between 2009 and 2022 in our institution were reviewed. PA development was compared between the groups using the PA index and the symmetry index.
A total of 130 patients were evaluated including 49 patients after DS and 81 after SPS. The most frequent primary diagnosis was tricuspid atresia in 27, followed by pulmonary atresia with intact ventricular septum in 19. At stage II palliation, PA index (P = .926), right PA index (P = .692), left PA index (P = .297), and the symmetry index (P = .650) were similar between the groups. At stage III Fontan completion, PA index (P = .115), right PA index (P = .868), and the symmetry index (P = .144) were similar between the groups. However, left PA index (60 vs 74 mm/m; P = .015) was lower, and the incidence of venovenous collaterals (24.2% vs 7.8%; P = .036) was higher in the DS group compared with the SPS group. Freedom from PA interventions between stage II and III palliation was lower in the DS group compared with the SPS group (P = .009).
In infants with univentricular heart after DS, freedom from PA interventions after stage II was lower and the left PA index was smaller, compared with those after SPS. Long-term outcomes after the Fontan procedure should be addressed in patients after DS.
我们旨在比较接受动脉导管支架置入术（DS）的单心室心脏婴儿与接受体肺分流术（SPS）作为初始姑息治疗的婴儿之间的肺动脉（PA）生长情况。
回顾了2009年至2022年在我们机构接受DS或SPS初始姑息治疗的所有依赖导管的肺血流婴儿。使用PA指数和对称指数比较两组之间的PA发育情况。
共评估了130例患者，其中49例接受DS治疗，81例接受SPS治疗。最常见的主要诊断是三尖瓣闭锁27例，其次是室间隔完整的肺动脉闭锁19例。在II期姑息治疗阶段，两组之间的PA指数（P = 0.926）、右PA指数（P = 0.692）、左PA指数（P = 0.297）和对称指数（P = 0.650）相似。在III期Fontan手术完成时，两组之间的PA指数（P = 0.115）、右PA指数（P = 0.868）和对称指数（P = 0.144）相似。然而，与SPS组相比，DS组的左PA指数较低（60 vs 74 mm/m；P = 0.015），静脉侧支发生率较高（24.2% vs 7.8%；P = 0.036）。与SPS组相比，DS组在II期和III期姑息治疗之间免于PA干预的比例较低（P = 0.009）。
与接受SPS治疗的婴儿相比，接受DS治疗的单心室心脏婴儿在II期后免于PA干预的比例较低，左PA指数较小。DS治疗后的患者应关注Fontan手术后的长期预后。
