Виртуальное стентирование как способ оптимизации стентирования выходного отдела правого желудочка перед проведением радикальной коррекции тетрады фалло у детей

Цель. Оценить эффективность стентирования выносящего отдела правого желудочка (ВОПЖ) с использованием технологии виртуального стентирования (ВС) для оптимизации результатов у детей с тетрадой Фалло и тетрадоподобными врожденными пороками сердца (ВПС).

Материалы и методы. Проведен анализ 22 случаев стентирования ВОПЖ у пациентов в возрасте 2,36 [0,73–3,07] месяца (2018– 2024 гг.). В 8 случаях планирование стентирования выполнялось на основе КТ-ангиографии с применением технологии виртуального стентирования.

Результаты. Процедурный успех составил 95%. Сатурация кислорода увеличилась с 80 [71–88]% до 95 [92–98]% (p < 0,001), градиент систолического давления (ГСД) снизился с 70 [41–80] до 30 [21–39] мм рт. ст. Применение ВС повысило точность позиционирования стента до 95% (против 78% без ВС) и сократило число реинтервенций (1 случай против 4).

Заключение. Стентирование ВОПЖ с использованием технологии виртуального моделирования демонстрирует высокую клиническую эффективность, обеспечивая значительное улучшение показателей оксигенации и гемодинамики, а также снижая частоту повторных интервенционных процедур.

1. Kirklin J.W., Barratt-Boyes B. G. Cardiac Surgery. 3rd ed. New York : Churchill Livingstone, 2003. 1632 p.

2. van der Linde D., Konings E. E., Slager M. A. et al. Birth prevalence of congenital heart disease worldwide: A systematic review and meta-analysis. Journal of the American College of Cardiology, 2011, vol. 58(21), pp. 2241-2247. - doi: 10.1016/j.jacc.2011.08.025.

3. Van Arsdell G.S., Maharaj G.S., Tom J. et al. What is the Optimal Age for Repair of Tetralogy of Fallot? Circulation, 2000, vol.102(19 Suppl 3), pp. 123-9. doi: 10.1161/01.cir.102.suppl_3.iii-123.

4. Fermanis G.G., Ekangaki A.K., Salmon A.P. et al. Twelve year experience with the modified Blalock-Taussig shunt in neonates. European Journal of Cardio-Thoracic Surgery, 1992, vol. 6(11), pp. 586-589. doi: 10.1016/1010-7940(92)90131-g.

5. Petrucci O., O’Brien S. M., Jacobs M. L. et al. Risk factors for mortality and morbidity after the neonatal Blalock-Taussig shunt procedure. Annals of Thora cic Surgery, 2011, vol. 92(2), pp. 642-651; discussion 651-2. doi: 10.1016/j.athoracsur.2011.02.030.

6. Gibbs J.L., O. Uzun, Blackburn M.E. et al. Right ventricular outflow stent implantation: An alternative to palliative surgical relief of infundibular pul monary stenosis. Heart, 1997, vol. 77(2), pp. 176-179. doi: 10.1136/hrt.77.2.176.

7. Dohlen G., Chaturvedi R.R., Benson L.N. et al. Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot. Heart, 2009, vol. 95(2), pp. 142-147. doi: 10.1136/hrt.2007.135723.

8. Quandt D., Ramchandani B., Penford G. et al. Right ventricular outflow tract stent versus BT shunt palliation in Tetralogy of Fallot. Heart, 2017, vol. 103(24), pp. 1985-1991. doi: 10.1136/heartjnl-2016-310620.

9. Quandt D., Ramchandani B., Stickley J. et al. Stenting of the Right Ventricular Outflow Tract Promotes Better Pulmonary Arterial Growth Compared With Modified Blalock-Taussig Shunt Palliation in Tetralogy of Fallot–Type Lesions. JACC Cardiovascular Interventions, 2017, vol. 10(17), pp. 1774-1784. doi: 10.1016/j.jcin.2017.06.023.

10. Abumehdi M., Nasef M.Al, Mehta C. et al. Short to medium term outcomes of right ventricular outflow tract stenting as initial palliation for symptomatic infants with complete atrioventricular septal defect with associated tetralogy of Fallot. Cathete rization and Cardiovascular Interventions, 2020, vol. 96(7), pp. 1445-1453. doi: 10.1002/ccd.29306.

11. Valderrama P., Garay F., Springmüller D. et al. Initial Experience in Chile with Stent Implantation in the Right Ventricle Outflow Tract in High-Risk Patients with Tetra logy of Fallot. Pediatric Cardiology, 2020, vol. 41(5), pp. 837-842. doi: 10.1007/s00246-020-02321-2.

12. Chernoglaz P.F., Linnik Yu.I., Bashkevich A.V. et al. Advantages of stenting of the right ventricular outlet in comparison with applying a modified blelock-Tausig anastomosis before performing a radical correction of the Fallot tetrad in children. Emergency cardio - logy and cardiovascular risks, 2019, vol. 3(1), pp. 532-538. (in Russian).

13. Morsina M.G., Pursanov M.G., Soynov I.A. et al. Critical form of tetralogy of fallot: right ventricular outflow tract stenting or modified blalock-taussig shunt? Russian journal of cardiology and cardiovascular surgery, 2023, vol. 16(6), pp. 575-581. doi: 10.17116/kardio202316061575. (in Russian).

14. Chernoglaz P.F., Linnik Yu.I., Bashkevich A.V. et al. Radical correction of the Fallot tetrad in children after stenting of the right ventricular outlet. Emergency cardiology and cardiovascular risks, 2019, vol. 3(2), pp.734-738. (in Russian).

15. Smith S.C. et al. Stent angioplasty of narrowed right ventricular outflow conduits and pulmonary arteries consistently reduces right ventricular systolic pressures. J Invasive Cardiol, 2018, vol. 30(4), pp. 150-156.

16. Morgan G.J., et al. Right ventricular outflow tract stenting is a safe and effective bridge to definitive repair in symptomatic infants with tetralogy of Fallot. JACC Cardiovasc Interv, 2023, vol. 16(5), pp. 567-575.

17. Abu Zahra H., et al. Right ventricular outflow tract stenting during neonatal and infancy periods: A multi-center, retrospective study. Pediatr Cardiol, 2018, vol. 39(6), pp. 1184-1190.

18. Chernoglaz P.F., Linnik Yu.I., Bashkevich A.V. et al. Stenosis of the right ventricu lar outlet as a step-by-step palliative inter- vention before radical correction of the Fallot tetrad in children. Emergency cardiology and cardiovascular risks, 2018, vol. 2(1), pp. 230-236. (in Russian).

19. Bertram H., Emmel M., Ewert P. et al. Stenting of native right ventricular outflow tract obstructions in symptomatic infants. J Interv Cardiol, 2015, vol. 28(3), pp. 279-287. doi: 10.1111/joic.12198.

20. Glatz A.C., Petit C.J., Goldstein B.H. et al. Comparison between patent ductus arteriosus stent and modified Blalock-Taussig shunt as palliation for infants with ductal-dependent pulmonary blood flow: insights from the congenital catheterization research collaborative. Circulation, 2018, vol. 137(6), pp. 589-601. doi: 10.1161/CIRCULATIONAHA.117.029987.

21. Bentham J.R., Zava N.K., Harrison W.J. et al. Duct stenting versus modified Blalock-Taussig shunt in neonates with duct-dependent pulmonary blood flow: associations with clinical outcomes in a multicenter national study. Circulation, 2018, vol. 1376), pp. 581-588. doi: 10.1161/CIRCULATIONAHA.117.028972.

22. Valderrama P., Garay F., Springmüller D. et al. Initial experience in chile with stent implantation in the right ventricle outflow tract in high-risk patients with tetralogy of Fallot. Pediatr Cardiol, 2020, vol. 41(4), pp. 837-842. doi: 10.1007/s00246-020-02321-2.

23. Peirone A., Contreras A., Guadagnoli A.F. et al. Right ventricular outflow tract stenting in severe tetralogy of Fallot: an option to the Blalock-Taussig shunt. Rev Argent Cardiol, 2019, vol. 87, pp. 125-130.

24. Stumper O., Ramchandani B., Noonan P. et al. Stenting of the right ventricular outflow tract. Heart, 2013, vol. 99(21), pp. 1603-1608. doi: 10.1136/heartjnl-2013-304155.