Transcatheter creation and enlargement of ventricular septal defects for relief of ventricular hypertension
Transcatheter creation and enlargement of ventricular septal defects for relief of ventricular hypertension
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DOI：
10.1016/j.jtcvs.2006.09.037
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发表时间：
2007-04-01
影响因子：
6
通讯作者：
Marshall, Audrey
中科院分区：
文献类型：
--
作者：
Meadows, Jeffery;Pigula, Frank;Marshall, Audrey
目的：室间隔缺损的形成或扩大在临床上是罕见的。在需要单心室姑息治疗的右心室双出口的情况下，室间隔缺损处进行性限制引起的左心室流出道梗阻是一种罕见但公认的困境。在这种情况下，手术室间隔缺损扩大可能是可取的，但风险损害房室瓣或传导系统。我们报告的结果，一种新的技术，经导管创建或扩大室间隔缺损作为一种替代再手术时，一个孤立的ventricle issue.Methods减压：8例患者进行了经导管室间隔缺损扩大或创建，和3这些患者进行了4个以前的手术尝试在左心室减压。结果：5例患者行室间隔缺损成形术，3例患者行室间隔缺损扩大术。初始干预导致室间隔缺损压差从76.9 mm Hg降至20.3 mm Hg（P= 0.004）。无手术死亡或持续性心脏传导阻滞。2例患者有中度至重度房室瓣返流，1例需要手术修复。在最后一次随访时，所有室间隔缺损均保持通畅，大多数病例由于支架边缘以外的肌肉肥大导致复发性梗阻。在1例患者中，室壁瘤的尺寸缩小。重复干预减少复发性梗阻，但复发rules.Conclusions：当再次手术被认为是高风险，经导管创建和扩大室间隔缺损是可能的，具有良好的短期效果。复发性梗阻很常见，但需要反复干预。需要进一步研究以确定临床获益。
Objective: Creation or enlargement of a ventricular septal defect is indicated in rare clinical situations. In the setting of double-outlet right ventricle requiring single-ventricle palliation, left ventricular outflow tract obstruction caused by progressive restriction at the ventricular septal defect poses an uncommon but recognized dilemma. In this situation surgical ventricular septal defect enlargement may be desirable but risks damage to the atrioventricular valve or conduction system. We report the results of a novel technique for transcatheter creation or enlargement of ventricular septal defects as an alternative to reoperation when decompression of an isolated ventricle is indicated.Methods: Eight patients had undergone transcatheter ventricular septal defect enlargement or creation, and 3 of these patients had undergone 4 prior surgical attempts at left ventricular decompression. Ventricular aneurysms had developed in 3 patients before intervention.Results: Five patients underwent ventricular septal defect creation, and 3 patients underwent enlargement of existing ventricular septal defects. Initial intervention resulted in a decreased ventricular septal defect pressure gradient from 76.9 mm Hg to 20.3 mm Hg ( P=.004). There was no procedural mortality or sustained heart block. Two patients had moderate-to-severe atrioventricular valve regurgitation, and 1 required surgical repair. At last follow-up, all ventricular septal defects remained patent, with recurrent obstruction in the majority of cases caused by muscular hypertrophy beyond the stent margins. In 1 patient a ventricular aneurysm has regressed in size. Repeat intervention reduced recurrent obstruction, but recurrence was the rule.Conclusions: When reoperation is considered high risk, transcatheter creation and enlargement of ventricular septal defects is possible with excellent short-term results. Recurrent obstruction is common but responds to repeated intervention. Further studies are required to establish clinical benefit.