Tetralogy of fallot with diminutive pulmonary arteries: Preoperative pulmonary valve dilation and transcatheter rehabilitation of pulmonary arteries
Tetralogy of fallot with diminutive pulmonary arteries: Preoperative pulmonary valve dilation and transcatheter rehabilitation of pulmonary arteries
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DOI：
10.1016/0735-1097(96)00044-7
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发表时间：
1996-06-01
影响因子：
24
通讯作者：
Lock, JE
中科院分区：
文献类型：
--
作者：
Kreutzer, J;Perry, SB;Lock, JE
目标.本研究旨在确定一种新的经导管治疗法乐四联症伴小肺动脉的结果。法洛四联症合并小肺动脉和严重肺动脉狭窄是罕见的，类似于法洛四联症合并肺动脉闭锁：有很高的发病率，肺动脉分支异常，狭窄和需要多次手术。由于导管-手术联合方法有助于这些患者的修复，因此这种方法可能有益于那些肺动脉小和肺动脉狭窄的患者。回顾性分析1989年1月至1995年1月间10例经导管肺动脉瓣球囊扩张术的临床、导管及手术资料。最初，Nakata指数范围为20至98 mm（2）/m（2）（平均67 +/- 28 mm（2）/m（2））。肺动脉瓣首次球囊扩张（平均球囊/瓣环1.5 +/- 0.3），平均初始瓣环Z评分（-4.0 +/- 1）增加至-3.3 +/- 1.1（p < 0.01）。其他介入治疗包括肺动脉分支球囊扩张术（7例患者，23支血管）和肺动脉侧枝通道弹簧圈栓塞术（8例患者，31条侧枝通道）。术前随访导管检查时，平均肺动脉瓣环Z评分为-3.1 +/- 0.7，Nakata指数增加至143 +/- 84 mm（2）/m（2）（p < 0.03）。所有患者均成功完成了完整的手术修复。在平均2.6 +/- 2年的随访期内，右心室压力为
Objectives. This study sought to determine the results of a novel transcatheter management approach in tetralogy of Fallot with diminutive pulmonary arteries.Background. Tetralogy of Fallot with diminutive pulmonary arteries and severe pulmonary stenosis is rare and resembles tetralogy of Fallot with pulmonary atresia: There is a high incidence of aortopulmonary collateral channels, arborization abnormalities, stenoses and need for multiple operations. Because a combined catheter-surgery approach facilitates repair in these patients, such an approach may benefit those with diminutive pulmonary arteries and pulmonary stenosis.Methods. Clinical, catheterization and surgical data were studied retrospectively for 10 such patients undergoing preoperative pulmonary valve balloon dilation, among other transcatheter interventions, from January 1989 to January 1995.Results. Initially, the Nakata index ranged from 20 to 98 mm(2)/m(2) (mean 67 +/- 28 mm(2)/m(2)). The pulmonary valve was first balloon dilated (mean balloon/annulus 1.5 +/- 0.3), and the mean initial valve annulus Z score (-4.0 +/- 1) increased to -3.3 +/- 1.1 (p < 0.01). Other interventions included branch pulmonary artery balloon dilation (7 patients, 23 vessels) and coil embolization of aortopulmonary collateral channels (8 patients, 31 collateral channels). At preoperative follow-up catheterization, the mean pulmonary annulus Z score was -3.1 +/- 0.7, and the Nakata index increased to 143 +/- 84 mm(2)/m(2) (p < 0.03). All patients underwent complete surgical repair successfully. At a mean follow up period of 2.6 +/- 2 years, right ventricular pressure was