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

Efficacy of transcatheter pulmonary valve perforation in neonates with pulmonary atresia with intact ventricular septum

目的探讨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(PA-IVS)的有效性及安全性。方法回顾性分析2018年10月至2021年10月于青岛大学附属妇女儿童医院接受经导管肺动脉瓣打孔术治疗的16例PA-IVS患儿的手术治疗及随访情况。比较手术前后右心室收缩压、经皮血氧饱和度(SpO2)变化,比较手术前与末次随访SpO2、超声心动图的变化。组间比较采用配对样本t检验。结果 16例PA-IVS患儿男10例、女6例,手术年龄为19(14,26)日龄,其中12例患儿成功行经导管肺动脉瓣打孔术,2例患儿转外科行直视下肺动脉瓣切开术,2例患儿转外科行经胸肺动脉瓣打孔术。12例成功行经导管肺动脉瓣打孔术治疗的PA-IVS患儿手术年龄为18(14,27)日龄,体重(3.6±0.4)kg,术后即刻右心室收缩压明显下降[(57±16)比(95±19)mmHg(1 mmHg=0.133 kPa),t=7.49,P<0.001];术后SpO2明显改善(0.90±0.48比0.75±0.09,t=-5.61,P<0.001)。12例成功行经导管肺动脉瓣打孔术治疗的PA-IVS患儿随访时间为22(7,33)个月,末次随访右心室与左心室横径比值较术前明显增加(0.55±0.05比0.45±0.05,t=-3.27,P=0.007);肺动脉瓣环Z值较术前明显增加(-0.78±0.23比-1.73±0.56,t=-8.52,P<0.001);三尖瓣瓣环Z值较术前明显增加(-0.52±0.12比-1.46±0.38,t=-10.40,P<0.001)。16例患儿均实现双心室循环,无死亡及严重的并发症发生。结论经导管肺动脉瓣打孔术治疗新生儿PA-IVS安全、有效,中期随访疗效确切。

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.