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新生儿三尖瓣闭锁合并最小程度依赖动脉导管的肺循环中的限制性心房交通

Restrictive Atrial Communication in Tricuspid Atresia With Minimal Duct-Dependent Pulmonary Circulation in a Newborn.

作者信息

Román Cristina M, Fuentes José Eduardo, Joubert Lia M, Ureña Velásquez Pedro, Toribio Acosta Janet

机构信息

Servicios Cardiovasculares Pediátricos, Santo Domingo, Dominican Republic.

Medicina Cardiovascular Asociada, Santo Domingo, Dominican Republic.

出版信息

JACC Case Rep. 2025 May 28;30(12):103515. doi: 10.1016/j.jaccas.2025.103515. Epub 2025 Apr 23.

DOI:10.1016/j.jaccas.2025.103515
PMID:40447366
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12235468/
Abstract

OBJECTIVES

To present ductal stenting and balloon atrial septostomy as minimally invasive alternatives to initial surgical palliation in cases of tricuspid atresia with restrictive foramen ovale and ductus arteriosus.

KEY STEPS

Retrograde DA access was achieved via the femoral artery. A stent was deployed in the DA. Balloon atrial septostomy was performed under echocardiographic guidance by advancing a catheter via the femoral vein through the foramen ovale. Balloon inflation created a 1 cm interatrial communication.

POTENTIAL PITFALLS

Complications such as ductal spasm or stent thrombosis and balloon rupture or cardiac trauma during balloon atrial septostomy are rare and can be minimized with precise technique and imaging guidance.

TAKE-HOME MESSAGES: Early identification of restrictive atrial communication and the determination of the effectiveness of pulmonary blood flow in tricuspid atresia are vital for preventing significant hemodynamic compromise. Ductal stenting with atrial septostomy is a viable, less invasive alternative to surgical shunt as first-stage palliation in newborns with duct-dependent tricuspid atresia.

摘要

目的

介绍在卵圆孔狭窄和动脉导管未闭的三尖瓣闭锁病例中，导管支架置入术和球囊房间隔造口术作为初始手术姑息治疗的微创替代方法。

关键步骤

通过股动脉实现逆行性动脉导管（DA）入路。在动脉导管内植入支架。在超声心动图引导下，经股静脉将导管推进穿过卵圆孔，进行球囊房间隔造口术。球囊充气形成1厘米的房间交通。

潜在陷阱

动脉导管痉挛或支架血栓形成以及球囊房间隔造口术期间球囊破裂或心脏创伤等并发症很少见，通过精确的技术和影像学引导可将其降至最低。

要点

早期识别狭窄的心房交通并确定三尖瓣闭锁时肺血流的有效性对于预防严重的血流动力学损害至关重要。对于依赖动脉导管的三尖瓣闭锁新生儿，导管支架置入术联合房间隔造口术是一种可行的、侵入性较小的手术分流替代方法，可作为一期姑息治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/fe1b318df633/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/926ad431a9e9/ga1.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/a9de1d164939/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/94a2d8da2116/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/e25e314c96a0/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/c0e867f6c5f8/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/fe1b318df633/gr6.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/926ad431a9e9/ga1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/d1845b272e44/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/a9de1d164939/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/94a2d8da2116/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/e25e314c96a0/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/c0e867f6c5f8/gr5.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d39d/12235468/fe1b318df633/gr6.jpg

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Comparative Analysis of Modified BT Shunt and Central Shunt in Pediatric Patients.改良 BT 分流术与中心静脉分流术在小儿患者中的对比分析。
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Influence of Shunt Type on Survival and Right Heart Function after the Norwood Procedure for Aortic Atresia.
Shunt 类型对主动脉缩窄患儿行 Norwood 手术后生存和右心功能的影响。
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Comparison Between Patent Ductus Arteriosus Stent and Modified Blalock-Taussig Shunt as Palliation for Infants With Ductal-Dependent Pulmonary Blood Flow: Insights From the Congenital Catheterization Research Collaborative.专利动脉导管支架与改良 Blalock-Taussig 分流术在依赖动脉导管的肺血流婴儿中的姑息治疗比较：来自先天性导管插入术研究协作组的见解。
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Tex Heart Inst J. 2015 Jun 1;42(3):281-4. doi: 10.14503/THIJ-13-3373. eCollection 2015 Jun.
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