Unmet Clinical Needs for Transcatheter Pulmonary Valves.
Unmet Clinical Needs for Transcatheter Pulmonary Valves.
复制标题
经导管肺动脉瓣的临床需求。
DOI：
10.1007/s10439-023-03328-5
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发表时间：
2023-11
影响因子：
3.8
通讯作者：
Kheradvar, Arash
中科院分区：
文献类型：
--
作者：
Agwu, Nnaoma;Recto, Michael R.;Kheradvar, Arash
先天性心脏病的一个共同特征是右心室流出道（RVOT）梗阻，这种梗阻可轻可重，在极端情况下可导致肺动脉瓣闭锁。RVOT异常通常可以通过手术或介入手段纠正。然而，这些患者中的大多数最终会发展为肺动脉瓣功能不全和最终的右心室扩张，这将需要在他们生命中的某个时候进行肺动脉瓣置换术，以减轻肺动脉瓣反流（PVR）对右心室（RV）的有害影响。Philip Bonhoeffer通过经导管方式植入肺动脉瓣的研究，为经导管肺动脉瓣置换术（TPVR）提供了基础。然而，仍然存在一些未满足患者人口需求的领域。在此，我们讨论了20kg以下儿童的临床未满足需求，并扩大了混合和其他TPVR方法的使用，以及目前肺瓣膜置换术的适应症和禁忌症。我们将从临床角度讨论市售肺瓣膜的局限性。最后，我们探讨了在年轻患者中使用经导管肺瓣膜混合和心室周围输送。
A common feature of congenital heart disease is the presence of right ventricular outflow tract (RVOT) obstruction that can range from mild to severe and can lead to atresia of the pulmonary valve, in extreme conditions. RVOT abnormalities can frequently be corrected surgically or via interventional means. However, most of these patients will ultimately develop pulmonary valve insufficiency and eventual right ventricular dilation, which will require a pulmonary valve replacement at some point in their life to mitigate the detrimental effects of pulmonary valve regurgitation (PVR) on the right ventricle (RV). The evolution from the studies done by Philip Bonhoeffer to implant a pulmonary valve via transcatheter means, have provided a bedrock for transcatheter pulmonary valve replacement (TPVR). Yet, several areas of unmet need for a demographic of patients still exist. Here, we discuss the clinical unmet needs in children under 20 Kg and expand the use of hybrid and other TPVR approaches along with the current indications and contraindications for pulmonary valve replacement. The constraints and limitations from commercially available pulmonary valves will be discussed from a clinical standpoint. Finally, we explore the use of hybrid and periventricular delivery of transcatheter pulmonary valves in younger patients.
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