新型Pul-Stent支架在姑息性右心室-肺动脉连接术后肺动脉狭窄中的应用Clinical application of Pul-Stent for pulmonary artery stenosis after palliative right ventricular-pulmonary artery shunt
万俊义,张戈军,潘湘斌,李守军,高华伟
摘要(Abstract):
目的评价新型Pul-Stent支架在姑息性右心室-肺动脉连接术(Sano分流术)后肺动脉狭窄中的临床应用价值。方法纳入2014年8月至2015年6月阜外医院9例肺动脉闭锁合并室间隔缺损行姑息性Sano分流术后肺动脉狭窄的患儿行新型Pul-Stent支架置入术。男5例,女4例;年龄4(1,9)岁;体重9~25(15.1±4.9)kg。结果 9例患儿共成功置入9枚支架,其中3例置入左肺动脉,6例置入右肺动脉。支架置入后,肺动脉狭窄处内径由术前(3.0±1.4)mm增加至(8.8±1.4)mm(P<0.001),跨狭窄处压力阶差由术前(73.2±21.4)mm Hg(1 mmHg=0.133 kPa)降至(36.1±18.8)mm Hg(P<0.001),右心室收缩压/主动脉收缩压比值由术前(0.7±0.2)降为(0.4±0.2)(P<0.001),差异均有统计学意义。术中1例球囊破裂,于外科术中置入肺动脉支架,无其他并发症发生。随访3(3,4)年,肺动脉支架无再狭窄、移位或断裂等,8例(8/9)接受了Ⅱ期根治术。结论新型Pul-Stent支架作为一种专门设计用于肺动脉狭窄的支架,应用于Sano分流术后肺动脉狭窄安全且有效。
关键词(KeyWords): 肺动脉闭锁;肺动脉;狭窄;支架
基金项目(Foundation):
作者(Author): 万俊义,张戈军,潘湘斌,李守军,高华伟
参考文献(References):
- [1] Leonard H, Derrick G, O’Sullivan J, et al. Natural and unnatural history of pulmonary atresia.Heart,2000,84(5):499-503.
- [2] Vesel S, Rollings S, Jones A, et al. Prenatally diagnosed pulmonary atresia with ventricular septal defect:echocardiography, genetics,associated anomalies and outcome.Heart,2006,92(10):1501-1505.
- [3]万俊义,张戈军,徐仲英,等.第Ⅱ代动脉导管未闭封堵器栓塞幼儿体肺侧支的临床应用.中国介入心脏病学杂志,2016,24(2):16-19.
- [4] Rothman A, Perry SB, Keane JF,et a1.Early results and follow-up of balloon angioplasty for branch pulmonary artery stenoses.J Am Coll Cardiol,1990,15(5):1109-1117.
- [5] O’Laughlin MP,Perry SB,Lock JE,et al. Use of endovascular stents in congenital heart disease. Circulation,1991,83(6):1923-1939.
- [6] Law MA,Shamszad P,Nugent AW,et a1.Pulmonary artery stents:long-term follow-up.Catheter Cardiovase Interv,2010,75(5):757-764.
- [7] Startfill R,Nykanen DG,Osorio S, et a1. Stent implantation is effective treatment of vascular stenosis in young infants with congenital heart disease:acute implantation and long-term follow-up results.Catheter Cardiovasc Interv,2008,71(6):831-841.
- [8] Stapleton GE, Hamzeh R,Mullins CE,et al. Simultaneous stent implantation to treat bifurcation stenoses in the pulmonary arteries:initial results and long-term follow up.Catheter Cardiovase lnterv,2009,73(4):557-563.
- [9]赵昌学,宋艳苹,冯冗.应用NuMED CP覆膜支架治疗成人主动脉缩窄.中国介入心脏病学杂志, 2017,25(4):206-209.
- [10]刘廷亮,郭颖,高伟,等.应用新型Pul–Stent支架治疗外科术后肺动脉分支狭窄的初步临床研究.中华儿科杂志, 2015,53(3):208-213.
- [11] B?kenkamp R, Blom NA, De Wolf D, et al. Intraoperative stenting of pulmonary arteries.Eur J Cardiothorac Surg,2005,27(4):544-547.
- [12] Menon SC,Cetta F,Dearani JA,et a1.Hybrid intraoperative pulmonary artery stent placement for congenital heart disease.Am J Cardiol,2008,102(12):1737-l741.
- [13] Van Gameren M, Witsenburg M,Takkenberg JJ, et a1. Early complications of stenting in patients with congenital heart disease:A multicenter study.Eur Heart J,2006,27(22):2709-2715.