Brown S C, Eyskens B, Mertens L, Stockx L, Dumoulin M, Gewillig M
University Hospital Gasthuisberg, Leuven, Belgium.
Heart. 1998 Mar;79(3):230-3. doi: 10.1136/hrt.79.3.230.
Obstruction of the venous pathways after Mustard repair for transposition of the great arteries is associated with an increased risk of arrhythmia and sudden death. The purpose of this study was to assess the effectiveness of the largest (tracheal 22 x 40 mm) Wallstents in treating baffle obstructions.
Retrospective analysis of patients with stented venous pathways.
Eleven patients with baffle obstruction after Mustard repair for transposition of the great arteries.
Stenoses were dilated with an 18 or 20 mm balloon. However, recoil was noticed in 11 patients: immediately (n = 7) or on repeat angiography (n = 4). Eighteen stents were implanted (mean (SD)) 18 (3.3) years postoperatively. After dilatation a tracheal Wallstent (11.5 F) was deployed.
Relief of obstruction, haemodynamic improvement.
In the inferior vena cava, 10 stents were deployed in seven baffle obstructions with an increase in diameter from 9.8 (2.4) mm to 16.5 (1.4) mm (p < 0.01) and a mean (SD) pressure gradient decrease from 5.1 (3.6) mm Hg to 1.4 (2.0) mm Hg; in the superior vena cava, eight stents were implanted increasing the diameter from 9.1 (3.7) mm to 15.6 (3.8) mm (p < 0.001) with a decrease in mean pressure gradient from 5.1 (2.7) mm Hg to 1.9 (1.5) mm Hg. No complications were experienced during implantation. No anticoagulation was prescribed. During follow up (1.7 (0.6) years; range, 0.9-2.6) no problems were noted; five patients were re-catheterised without change in measurements. There was no evidence of peal formation in any of the stents.
It is concluded that Wallstents are safe, easy to use, and effective in relieving baffle obstruction. Anticoagulation does not seem necessary.
大动脉转位Mustard修复术后静脉通路梗阻与心律失常和猝死风险增加相关。本研究的目的是评估最大尺寸（气管型22×40mm）Wallstent支架治疗挡板梗阻的有效性。
对置入支架的静脉通路患者进行回顾性分析。
11例大动脉转位Mustard修复术后出现挡板梗阻的患者。
用18或20mm球囊扩张狭窄部位。然而，11例患者出现了回缩：7例立即出现，4例在重复血管造影时出现。术后平均（标准差）18（3.3）年植入了18个支架。扩张后植入气管型Wallstent支架（11.5F）。
梗阻缓解、血流动力学改善。
在下腔静脉，7例挡板梗阻置入了10个支架，直径从9.8（2.4）mm增加到16.5（1.4）mm（p<0.01），平均（标准差）压力梯度从5.1（3.6）mmHg降至1.4（2.0）mmHg；在上腔静脉，植入8个支架，直径从9.1（3.7）mm增加到15.6（3.8）mm（p<0.001），平均压力梯度从5.1（2.7）mmHg降至1.9（1.5）mmHg。植入过程中未出现并发症。未进行抗凝治疗。随访期间（1.7（0.6）年；范围0.9 - 2.6年）未发现问题；5例患者再次进行导管检查，测量结果无变化。未发现任何支架内有血栓形成迹象。
得出结论，Wallstent支架安全、易用，在缓解挡板梗阻方面有效。似乎无需抗凝。
