Alessia Callegari, Mathieu Albertini, Guillaume Reverdito, Damien Bonnet, Sophie Malekzadeh-Milani
{"title":"急性右心室流出道感染性心内膜炎的介入治疗：通往手术或经皮肺瓣膜置换术的桥梁。","authors":"Alessia Callegari, Mathieu Albertini, Guillaume Reverdito, Damien Bonnet, Sophie Malekzadeh-Milani","doi":"10.1002/ccd.31348","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Infective endocarditis (IE) poses significant risks following percutaneous pulmonary valve implantation (PPVI) or surgical replacement (PVR).</p>\n </section>\n \n <section>\n \n <h3> Aims</h3>\n \n <p>This study evaluates the effectiveness of emergency percutaneous treatment in stabilizing patients with severe right ventricular dysfunction or obstructive cardiac shock, allowing for delayed surgical or percutaneous valve replacement.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This retrospective study examines 16 patients (age 19.9 [15.1–43.3] years) with right-sided IE treated with primary percutaneous intervention. Data collected included cardiac diagnosis, valve types, pathogens identified, procedural details, and outcomes.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Underlying diagnoses included aortic valve stenosis post-Ross surgery (43%), repaired tetralogy of Fallot (25%), common arterial trunk (18%), and repaired double outlet right ventricle (14%). Valve types varied, with Contegra Ven-Pro (56%) and Melody-valve (25%) being the most common. Diagnosis of IE occurred 66.5 (28.3–87.4) months postlast intervention/surgery, with emergency percutaneous treatment performed 2 (1–17) days postdiagnosis. Clinical presentations included obstructive cardiac shock (50%) and septic shock (25%). Preintervention RVOT velocity was 4.4 (4.2–5) m/s, with severely reduced RV function in 68%. Interventions included balloon dilatation, uncovered or covered stent implantation, and Melody valve implantation. Immediate resolution of RVOT obstruction was achieved in all patients, with significant reductions in RV systolic pressures (mean reduction 42.0 (30.2–50.0) mmHg) and improved RV function. No periprocedural deaths occurred, but one complication was noted. Follow-up included surgical repair (68%) and PPVI (18%). Mortality included one IE relapse and one surgical death.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Emergency percutaneous interventions can stabilize patients with RVOT obstruction due to IE, enabling delayed surgical or percutaneous interventions.</p>\n </section>\n </div>","PeriodicalId":9650,"journal":{"name":"Catheterization and Cardiovascular Interventions","volume":"105 3","pages":"588-596"},"PeriodicalIF":2.1000,"publicationDate":"2024-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Interventional Treatment of Acute Right Ventricular Outflow Tract Infectious Endocarditis: A Bridge to Surgical or Percutaneous Pulmonary Valve Replacement\",\"authors\":\"Alessia Callegari, Mathieu Albertini, Guillaume Reverdito, Damien Bonnet, Sophie Malekzadeh-Milani\",\"doi\":\"10.1002/ccd.31348\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>Infective endocarditis (IE) poses significant risks following percutaneous pulmonary valve implantation (PPVI) or surgical replacement (PVR).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Aims</h3>\\n \\n <p>This study evaluates the effectiveness of emergency percutaneous treatment in stabilizing patients with severe right ventricular dysfunction or obstructive cardiac shock, allowing for delayed surgical or percutaneous valve replacement.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This retrospective study examines 16 patients (age 19.9 [15.1–43.3] years) with right-sided IE treated with primary percutaneous intervention. Data collected included cardiac diagnosis, valve types, pathogens identified, procedural details, and outcomes.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Underlying diagnoses included aortic valve stenosis post-Ross surgery (43%), repaired tetralogy of Fallot (25%), common arterial trunk (18%), and repaired double outlet right ventricle (14%). Valve types varied, with Contegra Ven-Pro (56%) and Melody-valve (25%) being the most common. Diagnosis of IE occurred 66.5 (28.3–87.4) months postlast intervention/surgery, with emergency percutaneous treatment performed 2 (1–17) days postdiagnosis. Clinical presentations included obstructive cardiac shock (50%) and septic shock (25%). Preintervention RVOT velocity was 4.4 (4.2–5) m/s, with severely reduced RV function in 68%. Interventions included balloon dilatation, uncovered or covered stent implantation, and Melody valve implantation. Immediate resolution of RVOT obstruction was achieved in all patients, with significant reductions in RV systolic pressures (mean reduction 42.0 (30.2–50.0) mmHg) and improved RV function. No periprocedural deaths occurred, but one complication was noted. Follow-up included surgical repair (68%) and PPVI (18%). 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Interventional Treatment of Acute Right Ventricular Outflow Tract Infectious Endocarditis: A Bridge to Surgical or Percutaneous Pulmonary Valve Replacement
Background
Infective endocarditis (IE) poses significant risks following percutaneous pulmonary valve implantation (PPVI) or surgical replacement (PVR).
Aims
This study evaluates the effectiveness of emergency percutaneous treatment in stabilizing patients with severe right ventricular dysfunction or obstructive cardiac shock, allowing for delayed surgical or percutaneous valve replacement.
Methods
This retrospective study examines 16 patients (age 19.9 [15.1–43.3] years) with right-sided IE treated with primary percutaneous intervention. Data collected included cardiac diagnosis, valve types, pathogens identified, procedural details, and outcomes.
Results
Underlying diagnoses included aortic valve stenosis post-Ross surgery (43%), repaired tetralogy of Fallot (25%), common arterial trunk (18%), and repaired double outlet right ventricle (14%). Valve types varied, with Contegra Ven-Pro (56%) and Melody-valve (25%) being the most common. Diagnosis of IE occurred 66.5 (28.3–87.4) months postlast intervention/surgery, with emergency percutaneous treatment performed 2 (1–17) days postdiagnosis. Clinical presentations included obstructive cardiac shock (50%) and septic shock (25%). Preintervention RVOT velocity was 4.4 (4.2–5) m/s, with severely reduced RV function in 68%. Interventions included balloon dilatation, uncovered or covered stent implantation, and Melody valve implantation. Immediate resolution of RVOT obstruction was achieved in all patients, with significant reductions in RV systolic pressures (mean reduction 42.0 (30.2–50.0) mmHg) and improved RV function. No periprocedural deaths occurred, but one complication was noted. Follow-up included surgical repair (68%) and PPVI (18%). Mortality included one IE relapse and one surgical death.
Conclusions
Emergency percutaneous interventions can stabilize patients with RVOT obstruction due to IE, enabling delayed surgical or percutaneous interventions.
期刊介绍：
Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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