动脉导管支架置入术治疗不同类型新生儿肺动脉闭锁的随访结局

Outcomes of different types of pulmonary atresia in neonates treated by ductus arteriosus stenting

目的总结分析动脉导管支架置入术治疗不同类型新生儿肺动脉闭锁的随访结局。方法回顾性队列研究。纳入2014年4月至2021年6月在上海交通大学医学院附属新华医院接受动脉导管支架置入术患儿共19例为研究对象,分为室间隔完整型肺动脉闭锁(PA-IVS)和室间隔缺损型肺动脉闭锁(PA-VSD)两组。采用不同血管途径置入动脉导管支架,术后1、3、6和12个月及以后每年定期随访患儿基本情况和心脏超声心动图评估手术效果。组间比较采用独立样本t检验。结果 19例患儿中12例为PA-IVS,7例为PA-VSD。两组患儿均为足月儿,PA-IVS组和PA-VSD组患儿出生胎龄分别为(38.8±1.1)和(37.7±1.8)周,出生体重分别为(3.2±0.4)和(3.4±1.1)kg,手术时年龄分别为(10±9)和(12±7)日龄,差异均无统计学意义(均P>0.05)。12例PA-IVS患儿中,9例经股动脉途径,3例经股静脉途径成功置入动脉导管支架。7例PA-VSD患儿中,2例经股动脉途径成功置入,2例经股动脉途径置入失败,3例经左颈动脉途径成功置入动脉导管支架。所有患儿术后无血栓栓塞、动静脉瘘、假性动脉瘤等血管并发症发生。PA-VSD组中支架置入成功的5例患儿在随访至6月龄时分别行肺动脉闭锁根治术、室间隔缺损修补术、动脉导管支架取出术和动脉导管结扎术。所有患儿随访期无支架移位、狭窄,均实现了双心室循环,无死亡病例。结论动脉导管支架置入术可作为PA-IVS和PA-VSD患儿一期治疗方法,除传统的股静脉和股动脉途径外,颈动脉可作为支架置入的一条路径。

Objective To summarize the outcomes of different types of pulmonary atresia in neonates treated by ductus arteriosus stenting.Methods This study was a retrospective cohort study.A total of 19 neonates who had pulmonary atresia treated by ductus arteriosus stenting in Xinhua Hospital,Shanghai Jiao Tong University School of Medicine from April 2014 to June 2021 were included.They were divided into the intact ventricular septum(PA-IVS)group and the ventricular septal defect(PA-VSD)group.Ductus arteriosus stents were implanted by different approaches.These children were followed up regularly at the 1,3,6,and 12 months after the surgery and annually since then to evaluate the outcome.Independent sample t-test was used for the statistical analysis.Results There were 12 children in PA-IVS group and 7 in PA-VSD group.All of them were full term in fants.The gestational age of the PA-IVS group and the PA-VSD group was(38.8±1.1)and(37.7±1.8)weeks,the birth weights were(3.2±0.4)and(3.4±1.1)kg,and the age at operation was(10±9)and(12±7)days,respectively,without significant difference(all P>0.05).Among the 12 children with PA-IVS,9 had stents successfully implanted through the femoral artery and 3 through the femoral vein.Of the 7 children with PA-VSD,2 had the stents successfully implanted via the femoral artery and 2 failed,and the remaining 3 had stents successfully implanted via the left carotid artery.There was no postoperative thromboembolism,arteriovenous fistula,pseudoaneurysm or other vascular complications.Five children with PA-VSD who had successful operations were followed up at 6 months of age.They all had the operation for pulmonary atresia,repair of the ventricular septal defect,removal of arterial duct stents,and ligation of the arterial duct.All children survived without any stent displacement or stenosis and biventricular circulation was achieved during the follow-up.Conclusions Ductus arteriosous stenting can be the first-stage treatment for children with PA-IVS and PA-VSD.In addition to the traditional femoral vein and femoral artery approach,the carotid artery can be used as a route for stent placement.