Kreutzer J, Perry S B, Jonas R A, Mayer J E, Castañeda A R, Lock J E
Department of Cardiology, Children's Hospital, Boston, Massachusetts 02115, USA.
J Am Coll Cardiol. 1996 Jun;27(7):1741-7. doi: 10.1016/0735-1097(96)00044-7.
This study sought to determine the results of a novel transcatheter management approach in tetralogy of Fallot with diminutive pulmonary arteries.
Tetralogy of Fallot with diminutive pulmonary arteries and severe pulmonary stenosis is rare and resembles tetralogy of Fallot with pulmonary atresia: There is a high incidence of aortopulmonary collateral channels, arborization abnormalities, stenoses and need for multiple operations. Because a combined catheter-surgery approach facilitates repair in these patients, such an approach may benefit those with diminutive pulmonary arteries and pulmonary stenosis.
Clinical, catheterization and surgical data were studied retrospectively for 10 such patients undergoing preoperative pulmonary valve balloon dilation, among other transcatheter interventions, from January 1989 to January 1995.
Initially, the Nakata index ranged from 20 to 98 mm2/m2 (mean 67 +/- 28 mm2/m2). The pulmonary valve was first balloon dilated (mean balloon/annulus 1.5 +/- 0.3), and the mean initial valve annulus Z score (-4.0 +/- 1) increased to -33 +/- 1.1 (p < 0.01) Other interventions included branch pulmonary artery balloon dilation (7 patients, 23 vessels) and coil embolization of aortopulmonary collateral channels (8 patients, 31 collateral channels). At preoperative follow-up catheterization, the mean pulmonary annulus Z score was -3.1 +/- 0.7, and the Nakata index increased to 143 +/- 84 mm2/m2 (p < 0.03). All patients underwent complete surgical repair successfully. At a mean follow-up period of 2.6 +/- 2 years, right ventricular pressure was < 70% systemic in all patients and < 50% systemic in seven.
In patients with tetralogy of Fallot, severe pulmonary stenosis and diminutive pulmonary arteries, initial pulmonary valve balloon dilation increases the annulus Z score and anterograde pulmonary blood flow and facilities simultaneous coiling of aortopulmonary collateral channels and access for branch pulmonary artery dilation, all of which results in pulmonary artery growth, simplifying surgical management.
本研究旨在确定一种针对肺动脉细小的法洛四联症的新型经导管治疗方法的效果。
肺动脉细小且伴有严重肺动脉狭窄的法洛四联症较为罕见，与肺动脉闭锁型法洛四联症相似：主肺动脉侧支血管发生率高、分支异常、存在狭窄且需要多次手术。由于联合导管-手术方法有助于这些患者的修复，因此这种方法可能使肺动脉细小且伴有肺动脉狭窄的患者受益。
对1989年1月至1995年1月期间接受术前肺动脉瓣球囊扩张及其他经导管干预的10例此类患者的临床、导管检查和手术数据进行回顾性研究。
最初，中田指数范围为20至98mm²/m²（平均67±28mm²/m²）。首先对肺动脉瓣进行球囊扩张（平均球囊/瓣环比例为1.5±0.3），平均初始瓣环Z值（-4.0±1）升至-3.3±1.1（p<0.01）。其他干预措施包括对分支肺动脉进行球囊扩张（7例患者，23支血管）以及对主肺动脉侧支血管进行弹簧圈栓塞（8例患者，31条侧支血管）。在术前随访导管检查时，平均肺动脉瓣环Z值为-3.1±0.7，中田指数增至143±84mm²/m²（p<0.03）。所有患者均成功接受了完全手术修复。平均随访期为2.6±2年，所有患者的右心室压力均<体循环压力的70%，7例患者<体循环压力的50%。
对于法洛四联症、严重肺动脉狭窄且肺动脉细小的患者，初始肺动脉瓣球囊扩张可增加瓣环Z值和肺前向血流，并便于同时对主肺动脉侧支血管进行弹簧圈栓塞以及对分支肺动脉进行扩张，所有这些均可使肺动脉生长，简化手术管理。
