ABSTRACT
Objective:
To explore the application value of percutaneous peripheral interventional
therapy in
pulmonary atresia with intact ventricular septal (PA-IVS).
Methods:
Retrospective case summary. The data was collected from 25
children who were hospitalized at the
Children's
Hospital,Zhejiang
University School of
Medicine from August 2019 to August 2022, had been diagnosed with PA-IVS by
echocardiography, and underwent interventional
treatment. The
sex, age, weight, operation
time,
radiation exposure time, and
radiation dose of the
patients were collected. The
patients were divided into the arterial duct stenting group and the non-stenting group. Preoperative tricuspid annular diameters and Z scores, right ventricular length diameters, and right ventricular/left ventricular length-diameter ratios were compared by paired t-tests. Right ventricular
systolic pressure difference,
oxygen saturation,
lactic acid before and after the
surgery were compared for 24
children who received percutaneous balloon pulmonary valvuloplasty. Right ventricular improvement in 25
children after operation was analyzed. The correlation between postoperative
oxygen saturation and postoperative right ventricular systolic
blood pressure difference, the degree of
pulmonary valve opening and the Z value of
tricuspid valve ring in the non-stenting group were analyzed.
Results:
A total of 25
patients with PA-IVS were enrolled in the study, of whom 19 were
males and 6
females, with an age at
surgery of 12 (6, 28) days and a weight of (3.7±0.5) kg. One of them underwent only stenting of the arterial duct; 20
children underwent only percutaneous
pulmonary valve perforation and
balloon angioplasty; 4
children underwent both
procedures. The Z-value of the tricuspid ring was -1.5±1.2 in the group with arterial duct stenting, and -0.1±0.4 in the group without stenting (t=2.77, P=0.010). The tricuspid regurgitant flow rate 1 month after
surgery was significantly lower than the preoperative ((3.4±0.6) vs. (4.8±0.9) m/s, t=6.62,P<0.001). In the 24
children with percutaneous
pulmonary valve perforation and
balloon angioplasty, the preoperative right ventricular systolic
blood pressure was (110±32) mmHg, and the postoperative systolic
blood pressure was (52±19) mmHg (1 mmHg=0.133 kPa) (F=59.55, P<0.001). The factors that may
affect postoperative
oxygen saturation in 20 cases of non-stenting group were analyzed. The results suggested that the pre and post-operative right ventricular systolic
blood pressure differences (r=-0.11, P=0.649), and the
pulmonary valve orifice opening (r=-0.31, P=0.201) and tricuspid annulus Z value (r=-0.18, P=0.452) at 1 month after the operation were not significantly correlated with the postoperative
oxygen saturation.
Conclusions:
Interventional
therapy can be used as the first choice for one-stage operation of PA-IVS. Percutaneous
pulmonary valve perforation and
balloon angioplasty are more suitable for
children with well-developed
right ventricles, tricuspid annulus, and
pulmonary arteries. While the smaller the tricuspid annulus, the more dependent it is on the
ductus arteriosus and thus
patients are more suitable for arterial duct stenting.