经皮自膨胀肺动脉瓣植入的初步经验

Initial experience of percutaneous pulmonary valve implantation using self-expanding valve

目的初步评估使用国产Venus P瓣膜行经皮肺动脉瓣植入术(percutaneous pulmonary valve implantation,PPVI)的安全性和有效性。方法选取2013年5月至2016年5月于本院行PPVI并完成3个月随访的14例患者为研究对象,统计分析手术成功率、并发症发生率,评价瓣膜功能及症状改善情况。结果入选的14例患者均为使用跨瓣补片行右心室流出道重建术后并发慢性肺动脉瓣反流(pulmonary regurgitation,PR)的患者。手术成功率为100%,所有患者瓣膜完全释放后均位置满意,未出现移位。1例患者术后1天出现发热,经抗感染及激素治疗后好转。1例患者术后3个月出现心房扑动,电复律后好转。术后3个月随访显示,患者纽约心脏病协会(NYHA)心功能分级显著改善(P<0.01);6分步行距离显著增加(P<0.01)。人工肺动脉瓣膜无轻度以上瓣膜反流,无瓣周漏,平均跨瓣压差为(16.9±6.3)mm Hg。所有患者瓣膜支架结构完整,均未出现移位,QRS波宽度显著变窄(P<0.03)。结论使用Venus-P瓣膜对我国先天性心脏病术后并发慢性PR的患者行PPVI安全、有效,但尚需更长时间、更大样本量的研究来证实。

Objective To evaluate the safety and efficacy of percutaneous pulmonary valve implantation（PPVI） using the domestic Venus P. Method 14 cases of patients who underwent PPVI in our hospital from May 2013 to May 2016 and completed 3 months follow-up were enrolled in the study. The success rate of procedure, incidence of complications, valve functions and changes of symptoms were analyzed. ResultA total of 14 patients, included 3 males and 11 females, with an average age of（35.1±7.6） years old, all had chronic pulmonary regurgitation（PR） after right ventricular outflow tract（RVOT） reconstruction using the trans-annular patch. The procedure success rate was 100%. The positions of valve were satisfied and no valve dislodgement occurred in all patients. 1 case had fever one day after procedure and was cured by antibiotics and steroids. 1 case had atrial flutter 3 months after procedure and was cured by electrical cardioversion. 3 months follow-up after procedure showed that NYHA grades were significantly improved, 6 minutes walk distances increased. Echocardiography showed that there was no pulmonary valve regurgitation severer than mild, no paravalvular regurgitation, and the trans-valvular pressure gradient was（16.9±6.3） mm Hg. Chest X rays showed that structure of the valve stents was complete and no valve dislodgement occurred in all patients. ECG showed QRS wave duration was significantly shortened. Conclusion Our initial experience showed that using Venus P in PPVI was safe and effective for Chinese patients with chronic PR after surgery for congenital heart disease, but it needs to be confirmed by further follow up and larger sample size studies.