Cheatham-Platinum支架置入术治疗儿童先天性心脏病血管狭窄的疗效评价

目的 评价NuMED Cheatham-Platinum(CP)支架置入术治疗儿童先天性心脏病(CHD)血管狭窄的即刻和早中期疗效.方法 2005年8月至2007年5月,采用CP支架置入治疗5例CHD血管狭窄(先天性主动脉缩窄1例,肺动脉狭窄4例).男3例,女2例,年龄4～15岁(中位年龄12岁),体重20～51 kg(中位体重24 kg).根据数字减影血管造影结果选择CP支架和NuMED双球囊,支架准确定位后先后充盈内外球囊扩张支架.结果 5例CHD血管狭窄进行了6次支架置入操作,共置入8只支架,均为8-zig CP支架,支架长度22～39 mm.除1例右肺动脉狭窄支架置入术中移位而于术后11个月重新置入第2只CP支架外,余4例6只支架即刻置入成功.跨狭窄段收缩压差由术前(43.43±25.61)mm Hg(1 mm Hg=0.133 kPa)降至术后(3.29±3.09)mm Hg(t=4.320,P<0.01),最窄处血管直径由术前(6.86±2.04)mm增加至术后(13.44±4.02)mm(t=-4.508,P<0.01).2例单侧肺动脉分支狭窄术后狭窄侧肺血流量占全肺血流量百分比分别由11.0%和13.0%增加至47.5%和52.2%,2例双侧肺动脉分支狭窄的右心室/主动脉收缩压比分别由术前62.3%和72.2%降至术后27.0%和33.3%.1例主动脉缩窄术后上肢血压由206/133 mm Hg降至156/95mm Hg.随访13～34个月(中位时间20个月),2只CP支架于术后6个月发生支架内再狭窄,余结果稳定无并发症发生.结论 CP支架置入术治疗儿童CHD血管狭窄安全可行,即刻和早中期疗效较好,但远期疗效有待进一步随访和更多病例的研究.

Therapeutic effect of Cheatham-Platinum stent implantation for vessel stenosis associated with congenital heart disease in children and adolescents

Objective Although NuMED Cheatham-Platinum (CP) stent was specifically designed to treat vascular obstructions associated with congenital heart disease (CHD),its application in pediatric patients is relatively uncommon,especially in the pulmonary artery stenosis.The aim of this study was to evaluate the immediate-,early- and intermediate-term results of CP stent implantation in the treatment of vessel stenosis associated with CHD in children and adolescents.Methods From August 2005 to May 2007,5 consecutive patients (3 boys and 2 girls) diagnosed as vascular stenosis associated with CHD underwent CP stent implantation in our institution.One patient had native coarctation of the aorta (CoA) and four patients had pulmonary artery stenosis.The median age and weight of patients were 12 years (range 4-15 years) and 24 kg (range 20-51 kg),respectively.The CP stent and NuMED Balloon-in-Balloon catheter were selected according to digital subtracted angiography measurements.After checking for correct position by aogingraphy,the inner balloon and outer balloon inflated successively to expand the stent to desired diameter.Results Totally 6 stem placement procedures were performed and 8 CP stents (8-zig,22-39 mm in length) were implanted in these 5 patients.All stents but one in a case of right pulmonary artery stenosis were immediately successfully placed in the target lesions without displacement during the procedures.For this case,a repeat procedure was performed and a second CP stent was reimplanted successfully 11 months later.After the procedure,the systolic pressure gradient across the stenosis decreased from (43.43±25.61) mm Hg (1 mm Hg=0.133 kPa) to (3.29±3.09) mm Hg (t=4.320,P<0.01) and the narrowest diameter of the stenotic vessels increased from (6.86±2.04) mm to (13.44±4.02) mm (t=-4.508,P<0.01).The percentage of pulmonary artery flow to the ipsilateral lung increased from 11.0% and 13.0% to 47.5% and 52.2% after the procedure in 2 cases of unilateral pulmonary artery branch stenosis,respectively.The ratio of right ventricular to aortic systolic pressure decreased from 62.3% and 72.2% to 27.0% and 33.3% in 2 cases of bilateral branch pulmonary artery stenosis,respectively.Upper limb blood pressure of one case of native CoA dropped greatly from 206/133 mm Hg to 156/95 mm Hg.During a median follow-up of 20 months (range13-34 months),the results have been stable without complications except 2 stents which developed intrastent restenosis 6 months after the procedure.Conclusion Our experience suggests that the CP stent implantation is safe and feasible for the treatment of vessel stenosis associated with CHD in children and adolescents.The immediate-,early- and interim results are encouraging,but long-term results remain to be further evaluated and demand many more cases to be studied.