Efficacy analysis on arterial catheter stents for pulmonary atresia with intact ventricular septum in newborns

Abstract

Objective To compare the efficacy of arterial stenting with that of traditional B-T shunt for neonatal pulmonary atresia with intact ventricular septum. Methods Twenty-six cases of neonatal pulmonary atresia with intact ventricular septum were treated at Children′s Hospital of Zhengzhou from December 2005 to December 2015, aged 3 to 23 days[(8.20±4.80) days], and weighted 2.80-3.88 (3.41±0.27) kg.Accompanied with pulmonary hypoplasia, all these patients were combined with PDA and ASD or PFO.Before operation, the peripheral oxygen saturation was kept in 61%-75%, averaged at 67%.Among them, 12 cases underwent arterial catheter stenting, and 14 cases received B-T shunt (including modified B-T shunt and central shunt) ductus ligation.After operation, the oxygen saturation in these children was observed, and they were examined by echocardiography and true lateral chest X-ray, blood flow situations in stents and shunts were assessed, and follow-up examinations were conducted in 1, 3, 6 and 12 months postoperatively. Results Stents were successfully inserted into these 12 cases.After traditional pulmonary shunt, patients′ peripheral oxygen saturation was (82.73±5.59)%, compared with that of patients after arterial catheter sten-ting (86.18±3.19)%, there was significant difference(t=10.71, P<0.05). In pulmonary shunt group, 2 cases died, 1 case died of postoperative heart failure, and the other case was complicated with pulmonary infection and died of respiratory failure; in catheter stent group, 1 case was complicated with postoperative supraventricular tachycardia and recovered after drug intervention.For the follow-up examinations 1, 3, 6 and 12 months after the operation, 1 case of B-T shunt in pulmonary shunt group was improved by central shunt due to slow blood flow, less shunt volume, and oxygen saturation decreased to 69%.For the catheter stent group, 1 case was improved by stent balloon dilatation due to declined peripheral oxygen saturation 2 months postoperatively, and after the operation, transcutaneous oxygen saturation was improved.No patients died in the catheter stent group. Conclusions In traditional B-T shunts, the operation is extensive, and complications are common, and the recovery turns slowly.Arterial catheter stenting can be used as the preferred method of treatment for one-stage surgical pulmonary atresia with intact ventricular septum to reduce the weakness feasibly and effectively. Key words: Pulmonary atresia; Pulmonary shunt; Infant, newborn; Artery catheter; Stent