Outcomes in Neonates with Pulmonary Atresia and Intact Ventricular Septum Underwent Pulmonary Valvulotomy and Valvuloplasty Using a Flexible 2-French Radiofrequency Catheter
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose : Outcomes in 6 neonates with pulmonary atresia and intact ventricular septum (PAIVS) undergoing radiofrequency pulmonary valvulotomy and valvuloplasty (RPVV) were reported to identify the factors favorable for RPVV as the treatment of choice. Materials and Methods: From May 2000 to January 2008, 6 patients with PAIVS were included in this retrospective study. They were aged 1 day to 90 days old. Study modalities included review of recordings of presentations and profiles of chest radiography, electrocardiography, echocardiography, and cardiac catheterization with angiography. Hemodynamic profiles from the echocardiography and the cardiac catheterization were analyzed. Results: Echocardiography showed severe tricuspid regurgitation, membranous atresia of the pulmonary valve, intact ventricular septum, patent ductus arteriosus, and hypoplastic right ventricle in 6 patients. The pulmonary valve annulus were 4.2 to 6.9 mm in diameters, and those of the tricuspid valve were 7.1 to 10.1 mm. Elevated serum level of cardiac enzymes were found in 1 patient with ventriculocoronary communication (VCC). At cardiac catheterization, the ratio of systolic pressure of the right ventricle to that of the left ventricle ranged from 1.43 to 2.33 before RPVV, and from 0.54 to 1.15 after RPVV (p=0.027). The pressure gradients ranged from 76 to 136 mmHg before RPVV, and from 15 to 39 mmHg after RPVV (p=0.028). The echocardiographic gradients ranged from 16 to 32 mmHg within 24 hours after RPVV, and from 15 to 50 mmHg at the follow-ups. Conclusion: RPVV can be a treatment of choice for neonates with PAIVS, if there is patent infundibulum, no right-ventricular dependent coronary circulation, and adequate tricuspid valve and pulmonary valve.
Abstract
Purpose : Outcomes in 6 neonates with pulmonary atresia and intact ventricular septum (PAIVS) undergoing radiofrequency pulmonary valvulotomy and valvuloplasty (RPVV) were reported to identify the factors favorable for RPVV as the treatment of choice. Materials and Methods: From May 2000 to January 2008, 6 patients with PAIVS were included in this retrospective study. They were aged 1 day to 90 days old. Study modalities included review of recordings of presentations and profiles of chest radiography, electrocardiography, echocardiography, and cardiac catheterization with angiography. Hemodynamic profiles from the echocardiography and the cardiac catheterization were analyzed. Results: Echocardiography showed severe tricuspid regurgitation, membranous atresia of the pulmonary valve, intact ventricular septum, patent ductus arteriosus, and hypoplastic right ventricle in 6 patients. The pulmonary valve annulus were 4.2 to 6.9 mm in diameters, and those of the tricuspid valve were 7.1 to 10.1 mm. Elevated serum level of cardiac enzymes were found in 1 patient with ventriculocoronary communication (VCC). At cardiac catheterization, the ratio of systolic pressure of the right ventricle to that of the left ventricle ranged from 1.43 to 2.33 before RPVV, and from 0.54 to 1.15 after RPVV (p=0.027). The pressure gradients ranged from 76 to 136 mmHg before RPVV, and from 15 to 39 mmHg after RPVV (p=0.028). The echocardiographic gradients ranged from 16 to 32 mmHg within 24 hours after RPVV, and from 15 to 50 mmHg at the follow-ups. Conclusion: RPVV can be a treatment of choice for neonates with PAIVS, if there is patent infundibulum, no right-ventricular dependent coronary circulation, and adequate tricuspid valve and pulmonary valve.
참고문헌 (26)
- de Leval M, "Decision making in the definitive repair of the heart with a small right ventricle", Circulation, 72, pp.II52~II60 (1985)
- Milliken JC, "Early and late results in the treatment of patients with pulmonary atresia and intact ventricular septum", Circulation, 72, pp.II61~II69 (1985)
- Hanley FL, "Outcomes in neonatal pulmonary atresia with intact ventricular septum. A multiinstitutional study", J Thorac Cardiovasc Surg, 105, pp.406~423 (1993)
- Humpl T, "Percutaneous balloon valvotomy in pulmonary atresia with intact ventricular septum: impact on patient care", Circulation, 108, pp.826~832 (2003)
- Wang JK, "Outcomes of transcatheter valvotomy in patients with pulmonary atresia and intact ventricular septum", Am J Cardiol, 84, pp.1055~1060 (1999)
- Coles JG, "Long-term results in neonates with pulmonary atresia and intact ventricular septum", Ann Thorac Surg, 47, pp.213~217 (1989)
- Lightfoot NE, "Analysis of survival in patients with pulmonary atresia and intact ventricular septum treated surgically", Int J Cardiol, 24, pp.159~164 (1989)
- Burrows PE, "Coronary angiography of pulmonary atresia, hypoplastic right ventricle, and ventriculocoronary communications", AJR Am J Roentgenol, 1554, pp.789~795 (1990)
- Williams WG, "Thromboexclusion of the right ventricle in children with pulmonary atresia and intact ventricular septum", J Thorac Cardiovasc Surg, 101, pp.222~229 (1991)
- Giglia TM, "Diagnosis and management of right ventricle-dependent coronary circulation in pulmonary atresia with intact ventricular septum", Circulation, 86, pp.1516~1528 (1992)
- Calder AL, "Coronary arterial abnormalities in pulmonary atresia with intact ventricular septum", Am J Cardiol, 59, pp.436~442 (1987)
- Fyfe DA, "Myocardial ischemia in patients with pulmonary atresia and intact ventricular septum", J Am Coll Cardiol, 8, pp.402~406 (1986)
- Freedom RM, "Evaluation of patients with pulmonary atresia and intact ventricular septum by double catheter technique", Am J Cardiol, 33, pp.892~895 (1974)
- Qureshi SA, "Transcatheter laser-assisted balloon pulmonary valve dilation in pulmonic valve atresia", Am J Cardiol, 15, pp.428~431 (1991)
- Rosenthal E, "ofrequency-assisted balloon dilatation in patients with pulmonary valve atresia and an intact ventricular septum", Br Heart J, 69, pp.347~351 (1993)
- Cheatham JP, "Successful transcatheter perforation of the atretic pulmonary valve membrane in a newborn using the new Coe radiofrequency end hole catheter", Cathet Cardiovasc Diagn, 45, pp.162~166 (1998)
- Coe JY, "Transaortic balloon valvoplasty of the pulmonary valve", Am J Cardiol, 78, pp.124~126 (1996)
- Park IS, "Radiofrequency pulmonary valvotomy using a new 2-French catheter", Cathet Cardiovasc Diagn, 45, pp.37~42 (1998)
- Latson L, "Transductal guidewire “rail” for balloon valvuloplasty in neonates with isolated critical pulmonary valve stenosis or atresia", Am J Cardiol, 73, pp.713~714 (1994)
- Atz AM, "Inhaled nitric oxide in the neonate with cardiac disease", Semin Perinatol, 21, pp.441~455 (1997)
- Adatia I, "Diagnostic use of inhaled nitric oxide after neonatal cardiac operations", J Thorac Cardiovasc Surg, 112, pp.1403~1405 (1996)
- Beghetti M, "Inhaled nitric oxide differentiates pulmonary vasospasm from vascular obstruction after surgery for congenital heart disease", Intensive Care Med, 25, pp.1126~1130 (1999)
- Journois D, "Inhaled nitric oxide as a therapy for pulmonary hypertension after operations for congenital heart defects", J Thorac Cardiovasc Surg, 107, pp.1129~1135 (1994)
- Miller OI, "Very-low-dose inhaled nitric oxide: a selective pulmonary vasodilator after operations for congenital heart disease", J Thorac Cardiovasc Surg, 108, pp.487~494 (1994)
- Curran RD, "Inhaled nitric oxide for children with congenital heart disease and pulmonary hypertension", Ann Thorac Surg, 60, pp.1765~1771 (1995)
- Luciani GB, "Surgical repair of transposition of the great arteries in neonates with persistent pulmonary hypertension", Ann Thorac Surg, 61, pp.800~805 (1996)