Stenting of the arterial duct and banding of the pulmonary arteries - Basis for combined Norwood stage I and II repair in hypoplastic left heart
Stenting of the arterial duct and banding of the pulmonary arteries - Basis for combined Norwood stage I and II repair in hypoplastic left heart
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DOI：
10.1161/hc0902.104709
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发表时间：
2002-03-05
期刊：
影响因子：
37.8
通讯作者：
Schranz, D
中科院分区：
文献类型：
--
作者：
Akintuerk, H;Michel-Behnke, I;Schranz, D
根据诺伍德手术，左心发育不良（HLH）患者的预后主要受成功的第一步姑息治疗的影响。另一种方法是心脏移植（HTX）。已有文献报道了在新生儿导管依赖性体循环血流和双侧肺动脉条索中进行导管支架植入术的可行性。但它仍有待阐明，这种方法是否允许一种新的策略，为患者HLH.Methods和结果，在患者与各种形式的HLH（n=11）和Escheroglycan E-1管理，导管支架进行球囊扩张Jo支架或Saxx支架。在经导管手术后1 - 3天通过手术完成双侧肺动脉结扎。根据需要，通过球囊扩张房间隔切开术确保通过房间隔的血流不受限制。进行了介入手术，无死亡。支架和导管通畅达331天。2例患者接受了HTX，8例患者在3.5至6个月时接受了姑息性一期手术，包括主动脉弓重建和双向腔静脉连接。有2例死亡。1例术前右心衰竭患者在重建手术后死亡，1例患者在导管支架植入术和双侧肺动脉结扎术后4个月死亡，等待HTX. Conclusions-本研究是第一个临床试验，表明在新生儿HLH中进行导管支架植入术，然后进行双侧肺动脉结扎术，可以结合新主动脉重建，这是HLH第一阶段缓解的一部分，建立双向空腔连接。此外，它允许HTX的机会后，延长等待期。
Background-Outcome of patients with hypoplastic left heart (HLH) is mainly influenced by the successful first-step palliation according to the Norwood procedure. An alternative approach is heart transplantation (HTX). The feasibility of ductal stenting in newborns with duct-dependent systemic blood flow and bilateral pulmonary artery banding has been reported. But it remains to be elucidated whether this approach allows a new strategy for patients with HLH.Methods and Results-In patients with various forms of HLH (n=11) and prostaoglandin E-1 administration, ductal stenting was performed with balloon expandable Jo stents or Saxx stents. Bilateral pulmonary artery banding was surgically accomplished I to 3 days after the transcatheter procedure. Unrestricted blood flow through the interatrial septum was secured by balloon dilatation atrial septotomy, as required. Interventional procedures were performed with no mortality. Stent and ductal patency were achieved for up to 331 days. Two patients underwent HTX, and 8 patients had a palliative 1-stage procedure with reconstruction of the aortic arch and bidirectional cavopulmonary connection at the age of 3.5 to 6 months. There were 2 deaths. One patient with preoperative right heart failure died after the reconstructive surgery, and 1 patient died 4 months after ductal stenting and bilateral banding awaiting HTX.Conclusions-The present study is the first clinical trial showing that stenting the duct followed by bilateral pulmonary artery banding in newborns with HLH allows the combination of neoaortic reconstruction, which is part of first-stage palliation of HLH, with the establishment of a bidirectional cavopulmonary connection. Additionally, it allows the chance for HTX after extended waiting periods.