The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology.Percutaneous procedures focusing on aortic and mitral valve replacement or intervent...The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology.Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status.Although techniquesof percutaneous pulmonary valve implantation have been described just a decade ago,two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide.In contrast,percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status.Taking into account that an "interdisciplinary challenging",heterogeneous population of patients previously treated by corrective,semi-corrective or palliative surgical procedures is growing inexorably,there is a rapidly increasing need of treatment options besides redo-surgery.Therefore,the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures,to update on current devices,to discuss indications and patient selection criteria,to report on clinical results and finally to consider future directions.展开更多
Background This study aimed to investigate the performance of handmade tri-leaflet expanded polytetrafluoroethylene(ePTFE)conduits in the absence of a suitable homograft.Methods Patients who underwent right ventricula...Background This study aimed to investigate the performance of handmade tri-leaflet expanded polytetrafluoroethylene(ePTFE)conduits in the absence of a suitable homograft.Methods Patients who underwent right ventricular outflow tract reconstruction with tri-leaflet ePTFE conduits or homografts between December 2016 and August 2020 were included.The primary endpoint was the incidence of moderate or severe conduit stenosis(>36 mmHg)and/or moderate or severe insufficiency.The secondary endpoint was the incidence of severe conduit stenosis(>64 mmHg)and/or severe insufficiency.Results There were 102 patients in the ePTFE group and 52 patients in the homograft group.The median age was younger[34.5(interquartile range:20.8-62.8)vs.60.0(interquartile range:39.3-81.0)months,P=0.001]and the median weight was lower[13.5(10.0-19.0)vs.17.8(13.6-25.8)kg,P=0.003]in the ePTFE group.The conduit size was smaller(17.9±2.2 vs.20.5±3.0 mm,P<0.001)and the conduit Z score was lower(1.48±1.04 vs.1.83±1.05,P—0.048)in the ePTFE group.There was no significant difference in the primary endpoints(log rank,T3=0.33)and secondary endpoints(log rank,P=0.35).Multivariate analysis identified lower weight at surgery[P=0.01;hazard ratio:0.75;95%confidence interval(CI)0.59-0.94]and homograft conduit use(P=0.04;hazard ratio:8.43;95%CI 1.14—62.29)to be risk factors for moderate or severe conduit insufficiency.No risk factors were found for moderate or severe conduit stenosis or conduit dysfunction on multivariate analysis.Conclusion Handmade tri-leaflet ePTFE conduits showed acceptable early and midterm outcomes in the absence of a suitable homograft,but a longer follow-up is needed.展开更多
Objective:The size and morphology of the right ventricular outflow tract(RVOT)in patients suffering from long-term pulmonary regurgitation(PR)after native RVOT(NRVOT)reconstruction are important factors affecting the ...Objective:The size and morphology of the right ventricular outflow tract(RVOT)in patients suffering from long-term pulmonary regurgitation(PR)after native RVOT(NRVOT)reconstruction are important factors affecting the feasibility,safety,and effectiveness of transcatheter pulmonary valve replacement.The purpose of this study was to evaluate the feasibility,safety,and effectiveness of a transthoracic Salus valve(Balance Medical Technology Co.,Ltd,Beijing,China)in patients with moderate-to-severe PR after NRVOT reconstruction.Methods:Patients with moderate-to-severe PR after NRVOT reconstruction were selected between June 2021 and November 2021 at Beijing Anzhen Hospital.Demographic data as well as preoperative,intraoperative,and follow-up data were reviewed.Results:Ten patients with moderate-to-severe PR after NRVOT reconstruction underwent physical examination,transthoracic echocardiography,and cardiovascular magnetic resonance imaging.Seven patients were selected for transthoracic Salus valve replacement.Six patients underwent implantation of the Salus valve successfully.One valve migrated and was embolized during recovery of the delivery device;the Salus valve was surgically explanted and sutured to the inner wall of the main pulmonary artery.At a mean follow-up of(5.5±1.1)months,dysfunction or migration of the Salus valve embolism was not observed.Conclusions:This early feasibility study demonstrates the feasibility,safety,and effectiveness of transthoracic implantation of a Salus valve in patients with moderate-to-severe PR after NRVOT reconstruction.The short-term effectiveness is clear,medium and long-term effectiveness requires longer follow-up.展开更多
目的:总结自制三瓣叶Goretex管道在先天性心脏病(先心病)患儿右心室流出道重建中的近期结果。方法:2016-12至2017-06期间采用自制三瓣叶Goretex管道重建右心室流出道患儿19例,平均年龄(5.9±3.6)岁,平均体重(20.2±8.2)kg。根...目的:总结自制三瓣叶Goretex管道在先天性心脏病(先心病)患儿右心室流出道重建中的近期结果。方法:2016-12至2017-06期间采用自制三瓣叶Goretex管道重建右心室流出道患儿19例,平均年龄(5.9±3.6)岁,平均体重(20.2±8.2)kg。根据患者年龄和体重,制定右心室流出道的直径目标值,将0.1 mm Goretex膜剪裁三片相同大小的椭圆形作为瓣叶,6/0 prolene线单纯连续缝合至Goretex管道,自制成三瓣叶Goretex管道。采集患儿出院时超声心动图评价带瓣管道内瓣口狭窄和反流程度情况,出院后1个月门诊超声心动图复查随访观察。结果:右心室双出口6例,矫正型大动脉转位4例,肺动脉闭锁4例,大动脉转位2例,共同动脉干1例,双根部调转术后外管道狭窄1例,主动脉瓣狭窄1例。单纯Rastelli术8例,Rastelli+Senning术1例,Rastelli+半Mustard术2例,Rastelli+上腔静脉右心房连接术(Glenn take down)2例,Rastelli+双侧双向Glenn例1例,右心室肺动脉外管道置换术3例,Ross术1例,共同动脉干矫治术1例;其中二次手术12例(63.2%)。手术均在体外循环下完成,术后常规阿司匹林(3 mg/kg口服QD)抗栓,全组患者无院内死亡和严重并发症发生,出院及随访时间1个月时超声心动图显示所有患者肺动脉瓣口均无狭窄,2例(10.5%)患者肺动脉瓣轻度反流,其余患者无反流。结论:自制三瓣叶Goretex管道重建先心病右心室流出道近期结果满意,但中远期结果需要进一步随访。展开更多
目的分析特发性右室流出道（RVOT）室性心律失常消融靶点特点,探讨其可能的机制。方法连续选取2013年1月至2014年12月行导管射频消融的RVOT起源室性心律失常（PVCs/VT）患者38例,借助三维标测系统于PVCs/VT时建立右室流出道三维构图,分...目的分析特发性右室流出道（RVOT）室性心律失常消融靶点特点,探讨其可能的机制。方法连续选取2013年1月至2014年12月行导管射频消融的RVOT起源室性心律失常（PVCs/VT）患者38例,借助三维标测系统于PVCs/VT时建立右室流出道三维构图,分析有效消融靶点的电生理特点。结果所有心律失常患者进行三维激动/电压标测显示,最早心室激动点/消融靶点均位于RVOT肺动脉瓣附近的电压移行区上（0.5-1.5 m V）,即电压移行区与正常电压区的交界处;其中有4例造影及三维图像与CT融合证实于肺动脉瓣上标测消融成功,并在肺动脉瓣上可以记录到大于1.5 m V的电压电位（心肌组织）。结论电压移行区很可能是成功消融特发性RVOT室性心律失常的有效靶点区域;部分于肺动脉瓣上成功消融的室性心律失常,可能与心肌束延伸有关。展开更多
目的研究带单瓣自体心包补片在右心室流出道重建术中的应用价值。方法 2006-07/2010-12月期间收治的48例复杂先天性心脏病患者行右心室流出道重建手术,其中法洛四联症（tetralogy of Fallot,TOF）21例,法洛四联症合并肺动脉闭锁（pulmon...目的研究带单瓣自体心包补片在右心室流出道重建术中的应用价值。方法 2006-07/2010-12月期间收治的48例复杂先天性心脏病患者行右心室流出道重建手术,其中法洛四联症（tetralogy of Fallot,TOF）21例,法洛四联症合并肺动脉闭锁（pulmonary atresia,TOF＋PA）12例,右心室双出口合并肺动脉瓣狭窄（double outlet right ventricleand pulmonary stenosis,DORV＋PS）10例,永存动脉干（persistent truncus arteriosus,PTA）5例;男30例,女18例,年龄0.8~16.0（5.2±4.1）岁;术中采用自体心包补片加宽右室流出道,再剪一小块半圆形心包设计成单瓣,缝制于心包补片上,其直径相当于重建后肺动脉瓣环直径。术后随访39例,9例失访,时间2~36（17.1±9.5）月。结果术后无死亡患者,无右室流出道再狭窄,超声显示术后早期血液动力学效果满意;但术后2年只有20%（2/10）患者仍保存正常的肺动脉瓣功能。结论采用带单瓣自体心包补片行右室流出道重建术,操作简便、安全,术后早期能极好的阻止肺动脉瓣返流,其作用虽不能持久,但远期也不会出现右室流出道再狭窄,适当选用能降低围手术期损伤。展开更多
文摘The field of percutaneous valvular interventions is one of the most exciting and rapidly developing within interventional cardiology.Percutaneous procedures focusing on aortic and mitral valve replacement or interventional treatment as well as techniques of percutaneous pulmonary valve implantation have already reached worldwide clinical acceptance and routine interventional procedure status.Although techniquesof percutaneous pulmonary valve implantation have been described just a decade ago,two stent-mounted complementary devices were successfully introduced and more than 3000 of these procedures have been performed worldwide.In contrast,percutaneous treatment of tricuspid valve dysfunction is still evolving on a much earlier level and has so far not reached routine interventional procedure status.Taking into account that an "interdisciplinary challenging",heterogeneous population of patients previously treated by corrective,semi-corrective or palliative surgical procedures is growing inexorably,there is a rapidly increasing need of treatment options besides redo-surgery.Therefore,the review intends to reflect on clinical expansion of percutaneous pulmonary and tricuspid valve procedures,to update on current devices,to discuss indications and patient selection criteria,to report on clinical results and finally to consider future directions.
基金This work was supported by National Key R&D Program of China(No.2017YFC1308100)Beijing Municipal Science and Technology Commission(No.Z201100005520001).
文摘Background This study aimed to investigate the performance of handmade tri-leaflet expanded polytetrafluoroethylene(ePTFE)conduits in the absence of a suitable homograft.Methods Patients who underwent right ventricular outflow tract reconstruction with tri-leaflet ePTFE conduits or homografts between December 2016 and August 2020 were included.The primary endpoint was the incidence of moderate or severe conduit stenosis(>36 mmHg)and/or moderate or severe insufficiency.The secondary endpoint was the incidence of severe conduit stenosis(>64 mmHg)and/or severe insufficiency.Results There were 102 patients in the ePTFE group and 52 patients in the homograft group.The median age was younger[34.5(interquartile range:20.8-62.8)vs.60.0(interquartile range:39.3-81.0)months,P=0.001]and the median weight was lower[13.5(10.0-19.0)vs.17.8(13.6-25.8)kg,P=0.003]in the ePTFE group.The conduit size was smaller(17.9±2.2 vs.20.5±3.0 mm,P<0.001)and the conduit Z score was lower(1.48±1.04 vs.1.83±1.05,P—0.048)in the ePTFE group.There was no significant difference in the primary endpoints(log rank,T3=0.33)and secondary endpoints(log rank,P=0.35).Multivariate analysis identified lower weight at surgery[P=0.01;hazard ratio:0.75;95%confidence interval(CI)0.59-0.94]and homograft conduit use(P=0.04;hazard ratio:8.43;95%CI 1.14—62.29)to be risk factors for moderate or severe conduit insufficiency.No risk factors were found for moderate or severe conduit stenosis or conduit dysfunction on multivariate analysis.Conclusion Handmade tri-leaflet ePTFE conduits showed acceptable early and midterm outcomes in the absence of a suitable homograft,but a longer follow-up is needed.
基金supported by the National Key Research and Development Program of China(2020YFC1107903).
文摘Objective:The size and morphology of the right ventricular outflow tract(RVOT)in patients suffering from long-term pulmonary regurgitation(PR)after native RVOT(NRVOT)reconstruction are important factors affecting the feasibility,safety,and effectiveness of transcatheter pulmonary valve replacement.The purpose of this study was to evaluate the feasibility,safety,and effectiveness of a transthoracic Salus valve(Balance Medical Technology Co.,Ltd,Beijing,China)in patients with moderate-to-severe PR after NRVOT reconstruction.Methods:Patients with moderate-to-severe PR after NRVOT reconstruction were selected between June 2021 and November 2021 at Beijing Anzhen Hospital.Demographic data as well as preoperative,intraoperative,and follow-up data were reviewed.Results:Ten patients with moderate-to-severe PR after NRVOT reconstruction underwent physical examination,transthoracic echocardiography,and cardiovascular magnetic resonance imaging.Seven patients were selected for transthoracic Salus valve replacement.Six patients underwent implantation of the Salus valve successfully.One valve migrated and was embolized during recovery of the delivery device;the Salus valve was surgically explanted and sutured to the inner wall of the main pulmonary artery.At a mean follow-up of(5.5±1.1)months,dysfunction or migration of the Salus valve embolism was not observed.Conclusions:This early feasibility study demonstrates the feasibility,safety,and effectiveness of transthoracic implantation of a Salus valve in patients with moderate-to-severe PR after NRVOT reconstruction.The short-term effectiveness is clear,medium and long-term effectiveness requires longer follow-up.
文摘目的:总结自制三瓣叶Goretex管道在先天性心脏病(先心病)患儿右心室流出道重建中的近期结果。方法:2016-12至2017-06期间采用自制三瓣叶Goretex管道重建右心室流出道患儿19例,平均年龄(5.9±3.6)岁,平均体重(20.2±8.2)kg。根据患者年龄和体重,制定右心室流出道的直径目标值,将0.1 mm Goretex膜剪裁三片相同大小的椭圆形作为瓣叶,6/0 prolene线单纯连续缝合至Goretex管道,自制成三瓣叶Goretex管道。采集患儿出院时超声心动图评价带瓣管道内瓣口狭窄和反流程度情况,出院后1个月门诊超声心动图复查随访观察。结果:右心室双出口6例,矫正型大动脉转位4例,肺动脉闭锁4例,大动脉转位2例,共同动脉干1例,双根部调转术后外管道狭窄1例,主动脉瓣狭窄1例。单纯Rastelli术8例,Rastelli+Senning术1例,Rastelli+半Mustard术2例,Rastelli+上腔静脉右心房连接术(Glenn take down)2例,Rastelli+双侧双向Glenn例1例,右心室肺动脉外管道置换术3例,Ross术1例,共同动脉干矫治术1例;其中二次手术12例(63.2%)。手术均在体外循环下完成,术后常规阿司匹林(3 mg/kg口服QD)抗栓,全组患者无院内死亡和严重并发症发生,出院及随访时间1个月时超声心动图显示所有患者肺动脉瓣口均无狭窄,2例(10.5%)患者肺动脉瓣轻度反流,其余患者无反流。结论:自制三瓣叶Goretex管道重建先心病右心室流出道近期结果满意,但中远期结果需要进一步随访。
文摘目的分析特发性右室流出道（RVOT）室性心律失常消融靶点特点,探讨其可能的机制。方法连续选取2013年1月至2014年12月行导管射频消融的RVOT起源室性心律失常（PVCs/VT）患者38例,借助三维标测系统于PVCs/VT时建立右室流出道三维构图,分析有效消融靶点的电生理特点。结果所有心律失常患者进行三维激动/电压标测显示,最早心室激动点/消融靶点均位于RVOT肺动脉瓣附近的电压移行区上（0.5-1.5 m V）,即电压移行区与正常电压区的交界处;其中有4例造影及三维图像与CT融合证实于肺动脉瓣上标测消融成功,并在肺动脉瓣上可以记录到大于1.5 m V的电压电位（心肌组织）。结论电压移行区很可能是成功消融特发性RVOT室性心律失常的有效靶点区域;部分于肺动脉瓣上成功消融的室性心律失常,可能与心肌束延伸有关。
