Schneider M, Zartner P, Sidiropoulos A, Konertz W, Hausdorf G
Department of Paediatric Cardiology, Humboldt University of Berlin, Germany.
Eur Heart J. 1998 Sep;19(9):1401-9. doi: 10.1053/euhj.1998.0977.
Little is known about the medium term results after stenting of the arterial duct in neonates and infants with duct-dependent cyanotic congenital heart disease. We report the results of stent implantation of the arterial duct in 21 neonates and infants. The defects for which the arterial duct was stented included pulmonary atresia with intact ventricular septum, critical pulmonary stenosis, and more complex defects with associated reduced pulmonary blood flow.
Palmaz stents were used and successfully implanted in all the 21 patients. There were no major complications during the stent implantation procedure although two hospital deaths occurred 2 and 14 days after stent implantation. Cardiac catheterization was repeated electively 3 to 6 months after stent implantation. Stent stenosis due to intimal proliferation was noted in 11/13 patients who underwent recatheterization. Stenosis of the inner stent lumen ranged from 25% to 100%, mean 74%. Re-dilatation of the stent was required in five patients who were awaiting corrective surgery. In babies with pulmonary atresia or critical pulmonary stenosis, who also underwent additional balloon dilatation of the pulmonary valve, spontaneous closure of the stented arterial duct was well tolerated and when it occurred, the right ventricular size had increased and the circulation was no longer duct-dependent. In patients who required subsequent surgical corrective treatment, stenting of the duct allowed the definite corrective operation to be performed as the first surgical procedure. During the follow-up period, ranging between 2 months and 2 years, mean 8.7 months increased growth of the pulmonary arteries was seen in all the patients. No distortion of the branch pulmonary arteries was seen.
In patients with cyanotic congenital heart disease stenting of the arterial duct is an effective alternative to surgical aorto-pulmonary shunts.
对于患有依赖动脉导管的紫绀型先天性心脏病的新生儿和婴儿，在动脉导管置入支架后的中期结果了解甚少。我们报告了21例新生儿和婴儿动脉导管支架植入的结果。置入动脉导管支架的缺陷包括室间隔完整的肺动脉闭锁、严重肺动脉狭窄以及伴有肺血流量减少的更复杂缺陷。
使用Palmaz支架并成功植入所有21例患者体内。在支架植入过程中没有发生重大并发症，尽管在支架植入后2天和14天有2例住院死亡。在支架植入后3至6个月选择性地重复进行心导管检查。在接受再次导管检查的13例患者中有11例发现因内膜增生导致的支架狭窄。支架内腔狭窄范围为25%至100%，平均为74%。5例等待矫正手术的患者需要对支架进行再次扩张。对于患有肺动脉闭锁或严重肺动脉狭窄且还接受了肺动脉瓣额外球囊扩张的婴儿，支架置入的动脉导管自发闭合耐受性良好，当发生这种情况时，右心室大小增加且循环不再依赖动脉导管。对于需要后续手术矫正治疗的患者，动脉导管支架置入使得确定性矫正手术能够作为首次手术进行。在随访期间，时间范围为2个月至2年，平均8.7个月，所有患者均可见肺动脉生长增加。未发现分支肺动脉扭曲。
对于紫绀型先天性心脏病患者，动脉导管支架置入是外科主肺动脉分流术的有效替代方法。
