Cao Brooke Liu, Mervis Jonathan, Adams Paul, Roberts Philip, Ayer Julian
The University of Sydney, Australia.
The Children's Hospital at Westmead, Sydney, Australia.
Int J Cardiol Congenit Heart Dis. 2022 Apr 18;8:100368. doi: 10.1016/j.ijcchd.2022.100368. eCollection 2022 Jun.
Branch pulmonary artery (PA) Stenting is an established strategy for PA stenosis in older children and adults. Its use in infants is less well established. We describe our experience of branch PA Stenting in infants <10 kg.
Retrospective chart review of infants <10 kg who underwent PA Stenting at The Children's Hospital, Westmead between 2010 and 2020. Pre and post-procedural angiograms were reviewed to determine PA size. Technical procedural success was defined as >50% increase in PA diameter. Procedural complications and need for PA re-intervention were ascertained.
Forty-one children (age 7.6 months, IQR 2.4-9.8 months, weight 5.9 ± 2.2 kg) had 43 primary Stent implantations (10/43 intraoperative 33/43 transcatheter; left pulmonary artery [LPA] 25/43, right pulmonary artery [RPA] 8/43 and bilateral 10/43). Diagnoses were tetralogy of Fallot (27%), hypoplastic left heart syndrome (24%), truncus arteriosus (12%), transposition of the great arteries (7%), other single ventricle (10%) and other biventricular (20%). 40/41 (98%) had undergone a cardiac intervention in the preceding 31 days, [IQR 1-181], with 17/41 having prior branch PA intervention. 14/41 patients had urgent Stenting. There were 2 minor and 1 major complications with no procedural mortality. LPA (LPA 2.3 ± 1.0 × 2.2 ± 1.2 mm LPA 5.2 ± 1.3 × 5.0 ± 1.7 mm, p < 0.01) and RPA (RPA 2.5 ± 0.8 × 1.9 ± 0.8 mm RPA 4.9 ± 1.0 × 4.1 ± 1.0 mm, p < 0.01) calibre increased post Stenting. 20/41 required branch PA reintervention (time to reintervention 13.6 months [IQR 8.2-29.3].
Branch PA Stenting is effective and safe in infants <10 kg with expected high rates of reintervention. Urgent PA Stenting provides relief of early post-operative haemodynamic compromise.
分支肺动脉（PA）支架置入术是大龄儿童和成人PA狭窄的既定治疗策略。其在婴儿中的应用尚未得到充分确立。我们描述了我们对体重<10 kg婴儿进行分支PA支架置入术的经验。
回顾性查阅2010年至2020年在韦斯特米德儿童医院接受PA支架置入术的体重<10 kg婴儿的病历。回顾术前和术后血管造影以确定PA大小。技术操作成功定义为PA直径增加>500%55%。确定操作并发症和PA再次干预的必要性。
41名儿童（年龄7.6个月，四分位间距2.4 - 9.8个月，体重5.9±2.2 kg）接受了43次原发性支架植入（术中10/43，经导管33/43；左肺动脉[LPA]25/43，右肺动脉[RPA]8/43，双侧10/43）。诊断包括法洛四联症（27%）、左心发育不全综合征（24%）、动脉干（12%）、大动脉转位（7%）、其他单心室（10%）和其他双心室（20%）。40/41（98%）在之前31天内（四分位间距1 - 181天）接受过心脏介入治疗，其中17/41曾接受过分支PA介入治疗。14/41例患者进行了紧急支架置入术。有2例轻微并发症和1例严重并发症，无手术死亡。支架置入术后LPA（LPA 2.3±1.0×2.2±1.2 mm，LPA 5.2±1.3×5.0±1.7 mm，p<0.01）和RPA（RPA 2.5±0.8×1.9±0.8 mm，RPA 4.9±1.0×4.1±1.0 mm，p<0.01）管径增加。20/41例需要对分支PA进行再次干预（再次干预时间为13.6个月[四分位间距8.2 - 29.3个月]）。
分支PA支架置入术对体重<10 kg的婴儿有效且安全，但再次干预率较高。紧急PA支架置入术可缓解术后早期的血流动力学障碍。
