经导管窦静脉缺损闭合术后持续和残留左向右分流的不同机制及其处理方法。

IF 0.9 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Pediatric Cardiology Pub Date : 2024-01-01 Epub Date: 2024-05-24 DOI:10.4103/apc.apc_190_23
Pramod Sagar, Kothandam Sivakumar
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引用次数: 0

摘要

使用有盖支架经导管闭合上腔静脉(SVC)形式的窦静脉缺损(SVDs)是近十年来出现的一种手术替代方法。放置在腔心交界处的有盖支架为右上肺静脉(RUPV)创造了一个屋顶,阻止左向右分流并将静脉重新导向左心房。手术文献清楚地记录了手术矫正后 SVC 和 RUPV 狭窄、窦房结功能障碍和持续残余分流的发生率,而在这种新的经导管介入治疗后,必须获得有关并发症发生率和随访结果的类似数据。由于前三尖瓣分流患者在临床上通常没有症状,因此进行矫正主要是为了防止右心容积持续超负荷,并使心腔得以重塑。任何矫正后残留的左向右分流都会导致右心持续扩张。残留血流可由多种机制造成,包括覆盖支架与 SVD 游离边缘的贴合不足、织物破损、SVC 极高处额外右侧肺静脉的持续异常引流或卵圆窝的并存缺损。这篇综述分析了不同的机制,解释了每种机制的经食道和血管造影图像,并针对各种原因提供了相应的解决方案。不同的机制需要不同的治疗原则。针对一种机制的残余分流的解决方案可能不适合通过另一种机制的残余血流。透彻了解这些机制将有助于操作员对这些 SVD 进行有效干预。
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Different mechanisms for persistent and residual left-to-right shunt after transcatheter sinus venosus defect closure and their management.

Transcatheter closure of superior vena cava (SVC) form of sinus venosus defects (SVDs) using covered stents is emerging as an alternative to surgery in the current decade. A covered stent placed in the cavoatrial junction creates a roof for the right upper pulmonary vein (RUPV) that stops the left-to-right shunt and redirects the vein to the left atrium. While surgical literature has clearly documented the incidence of stenosis of SVC and RUPV, sinus nodal dysfunction, and persistent residual shunts following surgical correction, it is imperative to have similar data after this new transcatheter intervention on the incidence of complications and follow-up outcomes. Since patients with pretricuspid shunts are often clinically asymptomatic, correction is primarily performed to prevent a persistent right heart volume overload and allow remodeling of the heart chambers. Any residual left-to-right shunt after a correction will result in persistent right heart dilatation. Residual flows can result from various mechanisms, including lack of apposition of the covered stent to the free edge of the SVD, fabric breach, and persistent anomalous drainage of additional right-sided pulmonary veins that drain very high in the SVC or can be due to a coexistent defect in the oval fossa. This review analyzes the different mechanisms, explains the transesophageal and angiographic images for each one, and offers solutions tailored for various reasons. Different mechanisms warrant different treatment principles. A solution for residual shunt from one mechanism may not be appropriate for residual flow through another mechanism. A thorough understanding would aid the operator in effective interventions for these SVDs.

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来源期刊
Annals of Pediatric Cardiology
Annals of Pediatric Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
1.40
自引率
14.30%
发文量
51
审稿时长
23 weeks
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