Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot
Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot
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DOI：
10.1136/hrt.2007.135723
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发表时间：
2009-02-01
期刊：
影响因子：
5.7
通讯作者：
Lee, K-J
中科院分区：
文献类型：
--
作者：
Dohlen, G.;Chaturvedi, R. R.;Lee, K-J
背景：新生儿法洛四联症（TOF）修复术死亡率较低。关于患有 TOF 和不良危险因素的紫绀或导管依赖婴儿的初始管理仍在继续争论。虽然可以并且已经在这些患者中进行修复，但它与发病率增加有关。目的：我们回顾了右心室流出道（RVOT）支架置入术对有 TOF 症状的小婴儿的有效性。方法：回顾了 1994 年 10 月至 2007 年 8 月期间接受了 11 次 RVOT 支架置入术的 9 名患者的临床、超声心动图、血管造影和血液动力学数据。 所有患者的肺动脉瓣均被认为无法挽救（瓣膜中位直径 3.7 毫米（范围 2.7-4.2），Z 得分 -6.7（范围 -9.7 至 -5.4）。RVOT 支架置入术将动脉氧饱和度从中位 73% (60-85%) 改善至 94% (90-98%) (p = 0.008)。左侧 Z 得分中位 肺动脉从支架植入前的-4.9（-7.8至-2.4）增加到手术修复前的-1.5（-4.2至-0.2）（p = 0.02）。右肺动脉的中位 Z 评分从 -3.7（-6.8 至 -1.9）增加至 -0.8（-2.5 至 0.1）（p = 0.008）。中田指数中位数从 56 增加 毫米(2)/米(2) (21-77) 至150 毫米(2)/米(2) (123-231) (p = 0.008)。没有出现手术并发症。六名患者已成功修复。没有死亡。结论：对于有症状的 TOF 婴儿，RVOT 支架置入术提供了一种安全有效的治疗策略，可以改善动脉血氧饱和度并促进肺动脉生长。
Background: Repair of neonatal tetralogy of Fallot (TOF) has low mortality. Debate continues regarding the initial management of cyanotic or duct-dependent infants with TOF and adverse risk factors. While repair can and has been performed in these patients, it is associated with increased morbidity.Objective: We review the effectiveness of right ventricular outflow tract (RVOT) stenting in the symptomatic young infant with TOF.Methods: Clinical, echocardiographic, angiographic and haemodynamic data were reviewed for nine patients who underwent 11 RVOT stenting procedures from October 1994 to August 2007.Results: The pulmonary valve was deemed unsalvageable in all patients (median valve diameter 3.7 mm (range 2.7-4.2), Z-score -6.7 (range -9.7 to -5.4). RVOT stenting improved arterial oxygen saturation from a median of 73% (60-85%) to 94% (90-98%) (p = 0.008). Median Z-score for the left pulmonary artery increased from -4.9 (-7.8 to -2.4) before stent implantation to -1.5 (-4.2 to -0.2) (p = 0.02) before surgical repair. Median Z-score for the right pulmonary artery increased from -3.7 (-6.8 to -1.9) to -0.8 (-2.5 to 0.1) (p = 0.008). Median Nakata index increased from 56 mm(2)/m(2) (21-77) to 150 mm(2)/m(2) (123-231) (p = 0.008). There were no procedural complications. Six patients have undergone successful repair. There were no deaths.Conclusions: In the symptomatic young infant with TOF, stenting of the RVOT provides a safe and effective management strategy, improving arterial oxygen saturation and encouraging pulmonary artery growth.