Efficacy of transcatheter pulmonary valve perforation in neonates with pulmonary atresia with intact ventricular septum.
10.3760/cma.j.cn112140-20220622-00578
- VernacularTitle:经导管肺动脉瓣打孔术治疗新生儿室间隔完整型肺动脉闭锁临床分析
- Author:
Si Bao WANG
1
;
Si Lin PAN
1
;
Gang LUO
1
;
Zhi Xian JI
1
;
Ai LIU
1
;
Yue Yi REN
1
Author Information
1. Heart Center, Women and Children's Hospital, Qingdao University, Qingdao 266034, China.
- Publication Type:Journal Article
- MeSH:
Child;
Male;
Infant, Newborn;
Humans;
Female;
Pulmonary Valve/surgery*;
Retrospective Studies;
Pulmonary Atresia/surgery*;
Heart Defects, Congenital
- From:
Chinese Journal of Pediatrics
2023;61(2):126-130
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To explore the efficacy and safety of transcatheter pulmonary valve perforation in the treatment of neonatal pulmonary atresia with intact ventricular septum (PA-IVS). Methods: The clinical data on surgical treatment and follow-up in 16 patients with PA-IVS who underwent transcatheter pulmonary valve perforation in Women and Children's Hospital, Qingdao University from October 2018 to October 2021 were analyzed retrospectively. The right ventricular systolic pressure and percutaneous oxygen saturation (SpO2) were compared before and after operation. In addition, the SpO2 and echocardiographic data at preoperative and the last follow-up were compared. Comparisons between groups were performed using paired-samples t test. Results: Among the 16 patients (10 males and 6 females) with the age at operation of 19 (14, 26) days, 12 cases underwent transcatheter pulmonary valve perforation successfully, 2 cases were transferred to surgery department for open-heart pulmonary valvulotomy, and the remaining 2 cases were transmitted to surgery department for transthoracic pulmonary valve perforation. The age at operation of the 12 patients who underwent transcatheter pulmonary valve perforation was 18 (14, 27) days, and the weight was (3.6±0.4) kg. The immediate postoperative right ventricular systolic pressure decreased significantly ((57±16) vs. (95±19) mmHg (1 mmHg=0.133 kPa), t=7.49, P<0.001), and the postoperative SpO2 was improved effectively (0.90±0.48 vs.0.75±0.09, t=-5.61, P<0.001). The follow-up time was 22 (7, 33) months for 12 patients who underwent transcatheter pulmonary valve perforation successfully. At the last follow-up, the ratio of right to left ventricular transverse diameter was significantly higher than that before operative (0.55±0.05 vs. 0.45±0.05, t=-3.27,P=0.007). Furthermore, the Z-scores of pulmonary valvular diameter (-0.78±0.23 vs. -1.73±0.56, t=-8.52, P<0.001) and the tricuspid valvular diameter (-0.52±0.12 vs. -1.46±0.38, t=-10.40, P<0.001) were all significantly higher than preoperative data. At last, all the patients achieved biventricular circulation without death or major complications. Conclusion: Transcatheter pulmonary valve perforation is a safe and effective therapy for neonatal PA-IVS, and its curative effect has been confirmed by the medium follow-up data.
