Transthoracic Balloon Pulmonary Valvuloplasty for Treatment of Congenial Pulmonary Atresia Patients with Intact Ventricular Septum

Lin, Zhiqin; Chen, Qiang; Cao, Hua; Zhang, Gui-Can; Chen, Dao-zhong; Wang, Qinmin; Qiu, Hanfan; Liao, Dong-Shan; Lin, Feng

doi:10.12659/msm.904043

Cited by 7 publications

(7 citation statements)

References 17 publications

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“…In recent years, mosaic therapy has become a new approach for right ventricular decompression in the early stage of PA/IVS, which overcomes the shortcomings of interventional and surgical treatment, 23 avoids the damage caused by cardiopulmonary bypass, with fast postoperative recovery, and could shorten the length of ICU stay.…”

Section: Discussionmentioning

confidence: 99%

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Type I and Ii Pulmonary Atresia With Intact Ventricular Septum in Infants-10-year Experience in Initial Surgery at One Center

Song¹,

Chen²

2021

Preprint

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Background: To explore the effect of initial surgery for type I and II pulmonary atresia with intact ventricular septum (PA/IVS). Methods: Patients with type I and II PA/IVS undergoing initial surgery were enrolled, including type I with systemic to pulmonary (BT) shunt+patent ductus arteriosus (PDA) ligation+mosaic surgery (surgical A), BT shunt+PDA ligation+pulmonary valve incision without extracorporeal circulation (surgical B), type II with BT shunt+PDA ligation+right ventricular outflow tract (RVOT) incision+transpulmonary annulus patch (TP) (surgical C), and BT shunt+PDA ligation+RVOT incision+TP+artificial pulmonary valve (surgical D). Mechanical ventilation time (MVT), length of ICU stay, mortality rate, tricuspid Z value (TZ), tricuspid regurgitation (TR), McGoon ratio, oxygen saturation (SpO2), pulmonary transvalvular pressure (PTP), pulmonary regurgitation (PR), survival rate and re-operation rate were compared between surgical A and B, and between surgical C and D.Results: After surgery, PR was greater by surgical A than by surgical B at 1 month (P<0.05); lower TZ and McGoon ratio and greater PR, PTP and TR at 3 months (P<0.05); lower SpO2 (P<0.05), greater PTP at 6 months (P<0.01); greater TR and PTP at 1 year (P<0.05). MVT and length of ICU stay were longer by surgical C than by surgical D (P<0.05). There was greater PR at discharge and 1 month (P<0.01); greater TR and PR, lower McGoon ratio and SpO2 at 3 months (P<0.05); lower TZ and PTP and greater PR and PTP at 6 months (P<0.05) and 1 year (P<0.01) respectively.Conclusion: Surgical B and D are superior to surgical A and C respectively.

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Section: Discussionmentioning

confidence: 99%

“…In order to avoid hypoxia intolerance, PDA was ligated after BT shunt without extracorporeal circulation, which could stabilize blood oxygen saturation, and avoid blood ow con icts from the right ventricle and PDA to the pulmonary artery. Mosaic therapy, which had achieved good clinical results [5], was as follows:…”

Section: Surgical Methodsmentioning

confidence: 99%

Type I and Ii Pulmonary Atresia With Intact Ventricular Septum in Infants-10-year Experience in Initial Surgery at One Center

Song¹,

Chen²

2021

Preprint

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“…In order to avoid hypoxia intolerance, PDA was ligated after BT shunt, which could stabilize blood SpO2, and avoid blood flow conflicts from the right ventricle to PDA. Balloon dilatation of pulmonary valve, which had achieved good clinical results [ 4 ], was as follows: Under direct vision, the pulmonary catheter was inserted into the pulmonary valve, and the pulmonary artery anulus was expanded under the guidance of transesophageal echocardiography (TEE). According to our experience, the expansion is safer when the ratio of balloon diameter to pulmonary valve annulus diameter is 1:1.3.…”

Section: Methodsmentioning

confidence: 99%

Type I and II pulmonary atresia with intact ventricular septum in infants: a 10-year experience in initial surgery at one center

Song

Chen

2022

BMC Cardiovasc Disord

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Background To explore the effect of initial surgery for type I and II pulmonary atresia with intact ventricular septum (PA/IVS). Methods 50 children with type I PA/IVS and 50 with type II PA/IVS who had undergone initial surgery were enrolled. Children with Type I were divided into groups A (n = 25) and B (n = 25). Group A had received BT shunt combined with PDA ligation and balloon dilatation of pulmonary valve, whereas group B had undergone BT shunt combined with PDA ligation and pulmonary valve incision. Children with type II were divided into groups C (n = 25) and D (n = 25). Group C had received BT shunt combined with PDA ligation, right ventricular outflow tract (RVOT) incision and transannular patch. Group D had undergone BT shunt combined with PDA ligation, RVOT incision, transannular patch and artificial pulmonary valve implantation. The differences in mechanical ventilation time, length of ICU stay, mortality rate, tricuspid Z value, tricuspid regurgitation, oxygen saturation, pulmonary regurgitation, McGoon ratio, pulmonary artery transvalvular pressure, survival rate were compared between groups A and B, between groups C and D respectively. Results The ventilator assistance time and length of ICU stay were greater in group C than in group D (80.96 ± 8.42 h vs. 65.16 ± 4.85 h, P = 0.045; 222.00 ± 11.72 h vs. 162.48 ± 7.91 h, P = 0.048). The pulmonary artery transvalvular pressure was significantly higher in group A than in group B at 3, 6, 12, 24 and 36 months after surgery (64.86 ± 4.13 mmHg vs. 53.04 ± 5.64 mmHg, P = 0.045; 69.47 ± 1.93 mmHg vs. 55.95 ± 4.04 mmHg, P = 0.005; 80.16 ± 3.76 mmHg vs. 73.24 ± 2.34 mmHg, P = 0.035; 62.95 ± 5.64 mmHg vs. 48.47 ± 7.44 mmHg, P = 0.04; 53.69 ± 4.89 vs. 45.77 ± 3.26, P = 0.02). Furthermore, the tricuspid Z value was significantly greater in group B than in group A at 3 and 24 months after surgery (− (1.37 ± 0.04) vs. − (1.43 ± 0.06), P = 0.03; − (0.41 ± 0.06) vs. − (0.51 ± 0.11), P = 0.02). Conclusions The effect of BT shunt combined with PDA ligation and pulmonary valve incision is superior to BT shunt combined with PDA ligation and balloon dilatation of pulmonary valve, and the effect of BT shunt combined with PDA ligation, RVOT incision, transannular patch and artificial pulmonary valve implantation is superior to BT shunt combined with PDA ligation, RVOT incision and transannular patch.

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“…46,47 However, some other authors describe transthoracic per-ventricular balloon pulmonary valvuloplasty under echocardiographic guidance instead of using percutaneous approach. 48,49 Nowadays, it is possible to detect structural heart defects in a fetus as early as 20 weeks of gestation. However, those babies born with complex CHD are died very early age of life or suffered lifelong.…”

Section: Future Prospectmentioning

confidence: 99%

Percutaneous balloon valvuloplasty of pulmonary valve stenosis: state of the art and future prospects

Talukder¹,

Li²,

Liang³

et al. 2020

Int Surg J

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This study is aimed to delineate readers with an overview of percutaneous balloon pulmonary valvuloplasty (PBPV) of pulmonary valve stenosis (PVS) and highlighting outcome based on influential and recent studies. It has been four decades since Kan et al first introduce PBPV. Since then, PBPV has recognized as a gold standard therapy for PVS of all ages. Nowadays, PBPV is practiced for a broad range of indication such as PVS, PV dysplasia and pulmonary atresia. Typically, PBPV is recommended when gradient across the PV is >50 mmHg. The procedure involves the placement of one or more balloon catheters across the stenotic PV with the guidance of a guidewire; thereafter, inflation of the balloons is done by pressure, thus producing valvotomy. Nowadays, PBPV is done by echocardiographic guidance, but previously, it was done by fluoroscopic guidance. The main disadvantage of fluoroscopy was the radiation injury of patients. The recently recommended balloon/annulus ratio is 1.2 to 1.25. Following the procedure, the dramatic reduction of pressure gradient, free motion of the PV leaflets with less doming, the rise of cardiac output have been noted, whereas complications may occur but are unusual and minimal. Significant predictors of restenosis include balloon/annulus ratio <1.2 and immediate post-PBPV gradient ≥30 mmHg. Only a few percentages of patients needed repeat PBPV. Long-term follow-up results are surprisingly excellent. In conclusion, it is our opinion that PBPV is equally successful in patients of all ages, while worldwide recognized studies prove the safety, feasibility, and effectiveness. However, for early detection of any complication, life-long clinical follow-up is mandatory.

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Transthoracic Balloon Pulmonary Valvuloplasty for Treatment of Congenial Pulmonary Atresia Patients with Intact Ventricular Septum

Cited by 7 publications

References 17 publications

Type I and Ii Pulmonary Atresia With Intact Ventricular Septum in Infants-10-year Experience in Initial Surgery at One Center

Type I and Ii Pulmonary Atresia With Intact Ventricular Septum in Infants-10-year Experience in Initial Surgery at One Center

Type I and II pulmonary atresia with intact ventricular septum in infants: a 10-year experience in initial surgery at one center

Percutaneous balloon valvuloplasty of pulmonary valve stenosis: state of the art and future prospects

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