Gibbs J L, Wren C, Watterson K G, Hunter S, Hamilton J R
Killingbeck Hospital, Leeds.
Br Heart J. 1993 Jun;69(6):551-5. doi: 10.1136/hrt.69.6.551.
To assess the feasibility of pulmonary artery banding, atrial septectomy or septostomy, and percutaneous stenting of the arterial duct in babies with the hypoplastic left heart syndrome.
Four infants with hypoplastic left heart syndrome.
Two supraregional paediatric cardiac centres.
Ductal patency was maintained initially with prostaglandin E. Banding of the proximal branch pulmonary arteries was performed through a median sternotomy and open atrial septectomy was performed if balloon septostomy was not. Stainless steel stents (Johnson & Johnson) mounted in a balloon catheter were implanted into the arterial duct under radiographic control and expanded to a diameter of approximately 8 mm, prostaglandin treatment was then stopped.
All the patients survived the immediate postoperative period and maintenance of wide ductal patency was achieved in three of the four patients by stent implantation. Two weeks after the procedure two babies died of right ventricular failure and respiratory infection: some distal ductal constriction had occurred in one where the stent was not quite sufficiently distally placed. One child was discharged home 15 days after treatment and was well at follow up at age 16 weeks and one was stable but required diuretic therapy five weeks after the procedure.
This new approach is technically feasible. At least in the short term it seems to offer hope of effective palliation for the hypoplastic left heart syndrome and it warrants further study.
评估肺动脉环扎术、房间隔切除术或造口术以及动脉导管经皮支架置入术在左心发育不全综合征患儿中的可行性。
4例左心发育不全综合征婴儿。
两个地区级以上儿科心脏中心。
最初用前列腺素E维持动脉导管通畅。通过正中胸骨切开术对近端分支肺动脉进行环扎，如果未进行球囊房间隔造口术，则进行开放性房间隔切除术。将安装在球囊导管中的不锈钢支架（强生公司）在X线控制下植入动脉导管，并扩张至直径约8mm，然后停止前列腺素治疗。
所有患者术后即刻存活，4例患者中有3例通过支架植入实现了动脉导管的广泛通畅。术后两周，2例婴儿死于右心室衰竭和呼吸道感染：其中1例支架放置远端不够充分，出现了一些远端导管狭窄。1例患儿治疗后15天出院，16周随访时情况良好，另1例术后5周情况稳定，但需要利尿剂治疗。
这种新方法在技术上是可行的。至少在短期内，它似乎为左心发育不全综合征的有效姑息治疗提供了希望，值得进一步研究。
