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【摘要】
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 回顾分析2005年8月至2007年5月CP支架置入术治疗5例儿童CHD血管狭窄（肺动脉狭窄4例，先天性主动脉缩窄1例）的临床资料。根据DSA结果选择CP支架型号和双球囊（Balloon-In-Balloon，BIB）大小，经股动脉或股静脉/右颈内静脉穿刺送入装载有CP支架的BIB球囊导管，准确定位后充盈内外球囊，扩张支架。术后以临床评估、经胸超声心动图等随访。结果
5例CHD血管狭窄共置入8只CP支架，均为8zig CP支架，支架长度22～39mm。除1例右肺动脉狭窄CP支架置入术中发生支架移位而于11个月后重新置入第2只CP支架外，余4例6只支架均即刻置入成功，支架位置良好，术中无并发症发生。跨狭窄段收缩压差由术前（43.43±25.61）mmHg降至术后（3.29±3.09）mmHg（t＝4.320，P＝0.005），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＝0.004）。2例单侧肺动脉分支狭窄支架置入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收缩压/主动脉收缩压比分别由术前62.3%和72.2%降为术后27.0%和33.3%，1例先天性主动脉缩窄上肢血压术后即刻显著下降，由206/133mmHg降为156/95mmHg。术后随访13～34个月（平均20.6月，中位时间20月），1例双侧肺动脉分支狭窄2只CP支架置入后发生再狭窄，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，但远期疗效尚有待进一步随访观察和更多病例的研究。 【关键词】
CP支架；经导管治疗；肺动脉狭窄；主动脉缩窄；先天性心脏病 Therapeutic evaluation
of Cheatham Platinum stent implantation for interventional treatment of vessel
stenosis in children and adolescents with congenital heart disease 【Abstract】 Objective Although NuMED
Cheatham Platinum (CP) stent, a new balloon-expandable intravascular stent, was
specifically designed to treat vascular obstructions associated with congenital
heart disease(CHD),but its application in pediatric population 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 Between August 2005 and May 2007,
clinical data of CP stent implantation for the treatment of vascular stenosis
in 5 patients with CHD were retrospectively analyzed. One patient had native coarctation
of the aorta (CoA) and four patients had pulmonary artery stenosis. The access
site was the femoral artery for CoA and femoral vein or right internal jugular
vein for pulmonary artery stenosis. The CP stent and NuMED Balloon-in-Balloon
(BIB) catheter were selected according to digital subtracted angiography (DSA) measurements.
The CP stents mounted to appropriate BIB balloons were advanced to the stenotic
vessel through the sheath, and after checking for correct position, the sheath
withdrew and the inner balloon and outer balloon inflated successively to
expand the stent to desired diameter. Follow-up was carried out by clinical
evaluation and transthoracic echocardiography. Results There were 3 boys
and 2 girls, aged 4 to 15 years(mean 10.8years, median 12 years) and weighing 20
to 51 kg(mean 31.6 kg, median 24 kg) at the time of implantation. In total, 8 stents
were implanted in 5 patients. All stents used in this study were 8 zig CP
stents from 22 to 39 mm in length. A second stent was reimplanted in one case
of right pulmonary artery stenosis after Blalock-Taussig shunt 11 months later
because of the first one dislocation during implantation. The remaining 6 CP
stents were successfully placed in the target lesions without complications
during balloon dilatation or stent implantation. After stent implantation, the
systolic pressure gradient across the stenosis decreased significantly from (43.43±25.61) mmHg to (3.29±3.09) mmHg (t＝4.320, P＝0.005) and
narrowest vessel diameter increased significantly from (6.86±2.04) mm to (13.44±4.02) mm(t＝－4.508，P＝0.004). The
percentage of pulmonary blood flow to the ipsilateral lung increased from 11.0%
and 13.0% to 47.5% and 52.2% after stent
implantation in two cases of unilateral pulmonary artery stenosis,
respectively. The ratio of the right ventricle systolic pressure to aortic
systolic pressure decreased from 62.3% (76/122mmHg) and 72.2% (65/90mmHg) to
27.0% (33/122mmHg) and 33.3% (30/90mmHg) in two cases of bilateral pulmonary
artery stenosis, respectively. Upper limb blood pressure of one case of native CoA
dropped greatly from 206/133mmHg to 156/95mmHg. During
follow-up of 13 to 34 months (mean 20.6 months, median 20 months), the results
were stable without complications except one case of bilateral pulmonary artery
stenosis developed intrastent restenosis. Conclusion
The CP stent is suitable for the
treatment of vessel stenosis in children and adolescents with CHD. The
immediate-,early- and intermediate-term results are encouraging, but long-term
results remains to be further evaluated and demands many more cases to be
studied. 【Key words】 CP-stent；Transcatheter therapy；Pulmonary artery stenosis；Coarctation of the aorta；Congenital heart disease |
