Early Clinical Experience With a Novel Self-Expanding Percutaneous Stent-Valve in the Native Right Ventricular Outflow Tract
Early Clinical Experience With a Novel Self-Expanding Percutaneous Stent-Valve in the Native Right Ventricular Outflow Tract
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DOI：
10.1002/ccd.25544
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发表时间：
2014-12-01
影响因子：
2.3
通讯作者：
Hijazi, Ziyad M.
中科院分区：
文献类型：
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作者：
Cao, Qi-Ling;Kenny, Damien;Hijazi, Ziyad M.
简介球囊可扩张经导管肺动脉瓣系统不适用于大多数右心室流出道 (RVOT) 康复术后患有慢性严重肺动脉瓣反流 (PR) 的患者。本报告描述了新型经导管自扩张肺动脉瓣系统（Venus P 瓣膜）用于慢性严重 PR 患者 RVOT 康复的临床应用和短期随访。方法根据具体情况选择自然 RVOT 和严重 PR 患者，作为该瓣膜早期临床经验的一部分。审查了患者人口统计数据以及术前、术中和随访数据。结果选择平均体重为 54.811.4 kg 的 5 名患者（四名女性）尝试瓣膜展开。患者基线时为 NYHA II 级 (n=3) 或 III 级 (n=2)。所有病例的 PR 均为 4 级，心脏 MRI 显示平均右心室舒张末期容积为 155.0 +/- 16.6 ml/m(2)。经胸超声心动图的平均最小环形直径为 22.8 +/- 2.5 毫米，平均 RVOT 直径为 31.8 +/- 5.1 毫米。所有 5 例病例均顺利成功完成瓣膜输送，平均透视时间为 22.8 +/- 8.8 分钟。使用的阀门尺寸为 26 (n=3)、30 (n=1) 和 32 (n=1)。平均肺动脉舒张压从 3 +/- 3.7 mm Hg 增加至 9.9 +/- 6.9 mm Hg (P=0.06)。在平均 3.4 +/- 2.5 个月的随访中，所有病例的 PR 等级均为 0 (n=3) 或 1 (n=2)。所有病例的 NYHA 等级均提高了至少一个等级，并且在随访 3 个月后，超声心动图评估的所有三名患者的右心室容量均已正常化。 结论 Venus P 瓣膜为手术引起的慢性严重 PR 患者的自然 RVOT 提供了出色的短期肺动脉瓣功能。 (c) 2014 年 Wiley 期刊公司。
IntroductionBalloon expandable transcatheter pulmonary valve systems are not applicable to the large majority of patients with chronic severe pulmonary regurgitation (PR) following surgical right ventricular outflow tract (RVOT) rehabilitation. This report describes the clinical use and short-term follow-up of a novel transcatheter self-expanding pulmonary valve system (Venus P Valve) for rehabilitation of the RVOT in patients with chronic severe PR.MethodsPatients with native RVOT and severe PR were selected on a case-by-case basis as part of early clinical experience with this valve. Patient demographics and pre-procedural, intra-procedural, and follow-up data were reviewed.ResultsFive patients (four females) with a mean weight of 54.811.4 kg were selected for attempted valve deployment. Patients were either NYHA class II (n=3) or class III (n=2) at baseline. PR was grade 4 in all cases with mean right ventricular end-diastolic volumes of 155.0 +/- 16.6 ml/m(2) on cardiac MRI. Mean minimum annular diameter on transthoracic echocardiogram was 22.8 +/- 2.5 mm and mean RVOT diameter was 31.8 +/- 5.1 mm. Uncomplicated successful valve delivery was achieved in all five cases with a mean fluoroscopy time of 22.8 +/- 8.8 min. Valve sizes used were 26 (n=3), 30 (n=1), and 32 (n=1). Mean pulmonary artery diastolic pressure increased from 3 +/- 3.7 mm Hg to 9.9 +/- 6.9 mm Hg (P=0.06). On mean follow-up of 3.4 +/- 2.5 months PR grade is 0 (n=3) or 1 (n=2) in all cases. NYHA class has improved at least one class in all cases and right ventricular volumes assessed by echocardiography have normalized in all three patients with follow-up to 3 months.ConclusionsThe Venus P Valve provides excellent short-term pulmonary valvar function in the native RVOT of patients with surgically induced chronic severe PR. (c) 2014 Wiley Periodicals, Inc.