PDF(Pubmed)
Abstract：
UNASSIGNED: Complete repair (CR) can be delayed in neonates with symptomatic tetralogy of Fallot (sTOF) using surgical or transcatheter palliation to relieve cyanosis. Balloon pulmonary valvuloplasty (BPV) is an established treatment for pulmonary valve stenosis; however, its effectiveness in palliating neonates with sTOF has not been well investigated.
UNASSIGNED: A retrospective chart review between 2005 and 2017 on neonates with sTOF who underwent initial BPV from 9 participating centers of the Congenital Cardiac Research Collaborative was performed. Primary outcome was CR at >30 days after BPV without interval reintervention (RI).
UNASSIGNED: In total, 47 neonates with sTOF underwent BPV, of whom 27 (57%) underwent CR at >30 days after BPV without RI. The median time to CR was 151 days (106-210). RI before CR occurred in 17 patients (36%): surgical shunt (n = 7), outflow tract stenting (n = 6), patent ductus arteriosus stenting (n = 2), and surgical outflow patch (n = 2). Valve-sparing repair at CR was performed in 6 patients (13%) after initial BPV. RI or CR ≤30 days from BPV was associated with smaller infundibular diastolic diameter (P = .004). An infundibular diastolic diameter of <3.4 mm demonstrated 75% sensitivity and 67% specificity to predict early CR or RI.
UNASSIGNED: BPV can be an effective palliative therapy in select neonates with sTOF to delay CR. A smaller diastolic infundibulum diameter is a predictor of RI or early CR, and valve-sparing repair is uncommon, making patient selection and alternative palliative methods key when considering BPV palliation in neonates with sTOF.
UNASSIGNED: A retrospective chart review between 2005 and 2017 on neonates with sTOF who underwent initial BPV from 9 participating centers of the Congenital Cardiac Research Collaborative was performed. Primary outcome was CR at >30 days after BPV without interval reintervention (RI).
UNASSIGNED: In total, 47 neonates with sTOF underwent BPV, of whom 27 (57%) underwent CR at >30 days after BPV without RI. The median time to CR was 151 days (106-210). RI before CR occurred in 17 patients (36%): surgical shunt (n = 7), outflow tract stenting (n = 6), patent ductus arteriosus stenting (n = 2), and surgical outflow patch (n = 2). Valve-sparing repair at CR was performed in 6 patients (13%) after initial BPV. RI or CR ≤30 days from BPV was associated with smaller infundibular diastolic diameter (P = .004). An infundibular diastolic diameter of <3.4 mm demonstrated 75% sensitivity and 67% specificity to predict early CR or RI.
UNASSIGNED: BPV can be an effective palliative therapy in select neonates with sTOF to delay CR. A smaller diastolic infundibulum diameter is a predictor of RI or early CR, and valve-sparing repair is uncommon, making patient selection and alternative palliative methods key when considering BPV palliation in neonates with sTOF.
摘要：
■对于有症状的法洛四联症（sTOF）的新生儿，通过手术或经导管姑息治疗可以延迟完全修复（CR）。球囊肺动脉瓣成形术（BPV）是肺动脉瓣狭窄的既定治疗方法；然而，其在sTOF缓解新生儿中的有效性尚未得到很好的研究。
■2005年至2017年期间，对9个参与先天性心脏研究合作中心的sTOF新生儿进行了回顾性图表回顾。主要结果是无间隔再干预（RI）的BPV后>30天的CR。
■总共，47例sTOF新生儿接受BPV，其中27人（57%）在无RI的BPV后>30天接受CR。达到CR的中位时间为151天(106-210)。17例患者发生CR前RI（36%）：手术分流（n=7），流出道支架置入术（n=6），动脉导管未闭支架术（n=2），和手术流出补片（n=2）。初次BPV后，有6例患者（13％）在CR时进行了瓣膜保留修复。从BPV开始的RI或CR≤30天与较小的漏斗舒张直径相关（P=.004）。漏斗状舒张直径<3.4mm表明预测早期CR或RI的敏感性为75％，特异性为67％。
■BPV在选择sTOF的新生儿中可以是一种有效的姑息治疗，以延迟CR。较小的舒张漏斗直径是RI或早期CR的预测因子，保留瓣膜的修复并不常见，考虑sTOF新生儿BPV缓解时，选择患者和其他姑息治疗方法至关重要。
■2005年至2017年期间，对9个参与先天性心脏研究合作中心的sTOF新生儿进行了回顾性图表回顾。主要结果是无间隔再干预（RI）的BPV后>30天的CR。
■总共，47例sTOF新生儿接受BPV，其中27人（57%）在无RI的BPV后>30天接受CR。达到CR的中位时间为151天(106-210)。17例患者发生CR前RI（36%）：手术分流（n=7），流出道支架置入术（n=6），动脉导管未闭支架术（n=2），和手术流出补片（n=2）。初次BPV后，有6例患者（13％）在CR时进行了瓣膜保留修复。从BPV开始的RI或CR≤30天与较小的漏斗舒张直径相关（P=.004）。漏斗状舒张直径<3.4mm表明预测早期CR或RI的敏感性为75％，特异性为67％。
■BPV在选择sTOF的新生儿中可以是一种有效的姑息治疗，以延迟CR。较小的舒张漏斗直径是RI或早期CR的预测因子，保留瓣膜的修复并不常见，考虑sTOF新生儿BPV缓解时，选择患者和其他姑息治疗方法至关重要。
