在动脉开关操作后,通过导管更换肺
Stephen Nageotte1, Arash Salavitabar2, Jenny E Zablah3
1Division of Pediatric Cardiology, Loma Linda University Children's Hospital, Loma Linda, California, USA.
概括
在动脉切换操作 (ASO) 后的大动脉d转移 (d-TGA) 的患者中,透气管肺置换 (TPVR) 是可行的. 然而,像冠状动脉压缩这样的解剖学挑战可以在这些患者中的很大一部分中排除TPVR.
科学领域:
- 心血管外科心血管外科
- 干预心脏病学 干预心脏病学
- 儿童心脏病学 儿童心脏病学
背景情况:
- 动脉切换手术 (ASO) 后的大动脉d转移 (d-TGA) 患者可能会出现右心室外流通道 (RVOT) 功能障碍.
- 肺反 (PR) 或狭窄是需要治疗的常见并发症,例如透气管肺置换 (TPVR).
- 在这个人群中,冠状动脉压缩是TPVR的潜在禁忌.
研究的目的:
- 评估TPVR在患者中可行性,这些患者已经接受了d-TGA的ASO.
- 识别可能在ASO后排除TPVR的解剖挑战.
- 在这个特定的患者群体中评估TPVR的结果.
主要方法:
- 追溯的多中心队列研究.
- 包括2008年至2020年期间接受TPVR心脏导管治疗的RVOT功能障碍后ASO患者.
- 对TPVR成功率,不良事件和排除解剖因素的分析.
主要成果:
- 在33名符合条件的患者中,TPVR在66%成功,RVOT梯度和PR显著降低.
- 冠状动脉压缩在24%的患者中预防了TPVR,在6%的患者中预防了大动脉根变形.
- 七名患者需要RVOT重新干预,TPVR后的中位数为5.3年.
结论:
- 在ASO后的d-TGA患者中,TPVR是对RVOT功能障碍的可行的治疗方法.
- 解剖学问题,特别是冠状动脉压缩和大动脉根扭曲,约三分之一的病例限制TPVR的适用性.
- 在这个ASO队列中,TPVR后RVOT重新干预的比率似乎高于之前报告的.
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