国产球囊扩张式瓣膜用于经导管肺动脉瓣置换的初步经验  

Preliminary experience of transcatheter pulmonary valve replacement using domestic balloon-expandable valve

作　　者：赵振刚[1] 李锐韬 魏薪[1] 彭勇[1] 魏家富[1] 何森[1] 李侨[1] 李晓[2] 李怡坚 李翔 周轩[3] 郑明霞[1] 陈果[4] 安琪[2] 陈茂[1] 冯沅[1] Zhao Zhengang;Li Ruitao;Wei Xin;Peng Yong;Wei Jiafu;He Sen;Li Qiao;Li Xiao;Li Yijian;Li Xiang;Zhou Xuan;Zheng Mingxia;Chen Guo;An Qi;Chen Mao;Feng Yuan(Department of Cardiology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Cardiovascular Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Radiology,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Anesthesiology,West China Hospital,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院心脏内科,成都610041 [2]四川大学华西医院心脏大血管外科,成都610041 [3]四川大学华西医院放射科,成都610041 [4]四川大学华西医院麻醉科,成都610041

出　　处：《中华心血管病杂志》2023年第8期825-831,共7页Chinese Journal of Cardiology

基　　金：四川省科技计划重大科技专项资助(2022ZDZX0030)。

摘　　要：目的初步探讨使用国产球囊扩张式瓣膜Prizvalve进行经导管肺动脉瓣置换(TPVR)的可行性及临床效果。方法本研究为单中心前瞻性单组观察性研究,连续纳入2021年9月至2023年3月于四川大学华西医院就诊、经评估适合通过球囊扩张式瓣膜进行TPVR治疗的外科术后右心室流出道功能障碍患者,均使用Prizvalve进行TPVR治疗。记录患者的临床、影像和手术资料、手术效果及随访结果。即刻效果主要通过临床植入成功率评价,定义为瓣膜顺利植入且术后超声心动图评估的肺动脉瓣反流程度在中度以下、肺动脉瓣峰值压差<40 mmHg(1 mmHg=0.133 kPa)。结果共纳入5例患者,其中4例男性,年龄14~37岁。初始诊断包括法洛四联症(2例)、永存动脉干(1例)、肺动脉闭锁(1例)和主动脉瓣下狭窄(1例,既往行Ross手术);4例通过同种或人工管道行右心室流出道重建,1例通过跨瓣补片技术重建右心室流出道。干预指征包括右心室流出道-肺动脉狭窄合并反流(3例)、单纯狭窄(1例)及单纯反流(1例)。4例存在右心室流出道-肺动脉狭窄的患者术前平均右心室流出道峰值流速为3.5 m/s,平均右心室流出道峰值压差为50.0 mmHg。除1例患者既往因主肺动脉严重狭窄已植入覆膜Cheatham-Platinum(CP)支架外,其余患者在术中均先预植入覆膜CP支架再进行瓣膜植入。5例患者均临床植入成功,围术期无严重并发症出现。术后超声心动图测量平均右心室流出道-肺动脉峰值流速为2.3 m/s,平均右心室流出道-肺动脉峰值压差为21.2 mmHg。术后患者症状均明显改善,所有患者均已完成3个月随访,其中4例已完成6个月随访,随访期内无感染性心内膜炎发生,最近一次随访时评估纽约心脏病协会(NYHA)心功能均为1级。结论对于解剖条件合适的外科术后右心室流出道-肺动脉功能障碍患者,通过国产球囊扩张式短瓣膜Prizvalve进行TPVR是可行的治疗方�Objectives To evaluate the feasibility and preliminary clinical results of transcatheter pulmonary valve replacement(TPVR)with the domestically-produced balloon-expandable Prizvalve system.Methods This is a prospective single-center observational study.Patients with postoperative right ventricular outflow tract(RVOT)dysfunction,who were admitted to West China Hospital of Sichuan University from September 2021 to March 2023 and deemed anatomically suitable for TPVR with balloon-expandable valve,were included.Clinical,imaging,procedural and follow-up data were analyzed.The immediate procedural results were evaluated by clinical implant success rate,which is defined as successful valve implantation with echocardiography-assessed pulmonary regurgitation<moderate and peak trans-pulmonary pressure gradient<40 mmHg(1 mmHg=0.133 kPa).Results A total of 5 patients were included,with 4 males,aged 14 to 37 years.The initial diagnosis included Tetralogy of Fallot(2 cases),truncus arteriosus(1 case),pulmonary atresia(1 case)and subaortic stenosis(1 case,prior Ross procedure).Four patients underwent RVOT reconstruction with homograft or artificial conduit,and one patient was treated with trans-annular patch technique.The indications of TPVR included RVOT obstruction and regurgitation(3 cases),isolated obstruction(1 case),and isolated regurgitation(1 case).Of the 4 patients with varying severity of ROVT obstruction,the average preprocedural peak jet velocity of RVOT was 3.5 m/s,and the average peak pressure gradient was 50.0 mmHg.Except for one patient,who had previously been implanted with a covered Cheatham-Platinum(CP)stent due to severe stenosis of the main pulmonary artery,other patients underwent pre-stenting with a covered CP stent before TPVR.Clinical implant success was achieved in all of the 5 patients,and there was no serious periprocedural complications.The average trans-pulmonary peak jet velocity and peak pressure gradient derived from postprocedural echocardiography was 2.3 m/s and 21.2 mmHg,respectively.All pati

关 键 词：肺动脉瓣 右心室流出道梗阻 球囊扩张式瓣膜 经导管肺动脉瓣置换 

分 类 号：R655.3[医药卫生—外科学]