复杂先天性心脏病右心室流出道重建术后重度肺动脉瓣返流合并右心衰竭患者经导管肺动脉瓣置换术后早期疗效观察

Early efficacy of transcatheter pulmonary valve replacement in patients with right heart failure complicated with severe pulmonary valve regurgitation after complex congenital heart disease right ventricular outflow tact reconstruction

目的评价复杂先天性心脏病右心室流出道重建术后重度肺动脉瓣返流(PR)合并右心功衰竭患者经导管肺动脉瓣置换术(TPVR)治疗的安全性及早期有效性。方法连续纳入2014年1月至2022年12月于中国医学科学院阜外医院接受TPVR且术前诊断为复杂先天性心脏病右心室流出道重建术后重度PR合并右心衰竭的患者,记录并分析患者的术前及术后半年随访资料,观察TPVR术后的早期(术后随访半年)疗效。结果共纳入19例患者,男性8例,女性11例,年龄为(26.74±3.40)岁。TPVR术后6个月[随访时间为(176±13)d]随访时,患者肺动脉瓣反流(P<0.001)及三尖瓣返流程度较术前明显改善(P<0.05),右心室舒张末期容积指数(RVEDVi)较术前明显缩小[(139.63±35.37)ml/m^(2)比(92.56±25.49)ml/m^(2),P<0.001]。但右心室射血分数(RVEF)较术前并无显著改善[(33.94±8.90)%比(34.85±9.27)%,P=0.51],术前及术后随访时心电图QRS间期变异无统计学意义[151(136,159)ms比148(127,160)ms,P=0.30]。结论TPVR可以显著改善右心衰竭患者的肺动脉瓣返流情况,缩小右心室、减轻右心容量负荷,但在术后早期右心室收缩功能无显著改善。

Objective To evaluate the safety and early efficacy of transcatheter pulmonary valve replacement(TPVR)in patients with severe pulmonary valve regurgitation(PR)accompanying right heart failure after complex congenital heart disease right ventricular outflow tract reconstruction.Method Patients with the diagnosis ofj right heart failure complicated with severe PR after complex congenital heart disease right ventricular outflow tact reconstruction in Fuwai Hospital,Chinese Academy of Medical Sciences,from January 2014 to December 2022 were enrolled.Preoperative and 6-month postoperative follow-up data were recorded to evaluate the early efficacy of TPVR.Results A total of 19 patients with 8 males and 11 females were enrolled.During the 6-month follow-up[(176±13)days]after TPVR,there was a significant improvement in the degree of pulmonary and tricuspid valve regurgitation compared with preoperative data(P<0.001 and P<0.05,respectively),and right ventricle end-diastolic volume index(RVEDVi)was significantly reduced[(139.63±35.37)mL/m^(2) vs.(92.56±25.49)mL/m^(2),P<0.001].However,there was no significant improvement in the right ventricular ejection fraction(RVEF)[(33.94±8.90)%vs.(34.85±9.27)%,P=0.51],nor was there a significant difference in QRS duration on the electrocardiogram before and after surgery[151(136,159)ms vs.148(127,160)ms,P=0.30].Conclusion TPVR can significantly improve PR and reduce the size of the right ventricle,thereby lessening right ventricular volume load in patients with right heart failure.However,there was no early recovery or improvement in right ventricular contractile function.