经皮自膨胀式肺动脉瓣植入术的长期随访

Objective To evaluate the long-term efficacy of percutaneous pulmonary valve implantation (PPVI) and the durability of the home-made self-expanding pulmonary valve (Venus-P).Methods From May,2013 to Nov.,2015,14 patients who underwent percutaneous pulmonary valve implantation at Zhongshan Hospital,Fudan University and received at least 1 year follow-up were enrolled,including 3 males and 11 females,with an average age of (35.8±7.8) years.All patients with tetralogy of Fallot received radical resection and developed severe pulmonary regurgitation.The long-term mortality,the operation related complications,the short-term and long-term effect of PPVI,as well as the durability and effect of the self-expanding pulmonary valve were evaluated in the 14 patients.Results Over an average follow-up period of (2.3±0.8) years (1.0-3.5 years),only 1 patient died (6.7%).During the follow-up,no deterioration,infective endocarditis,malignant arrhythmia and other serious complications was observed,and nobody needed reoperation.There was no valve displacement,valve stent fracture,obvious circumferential leakage and pulmonary regurgitation.After PPVI,an acute improvement in pulmonary artery diastolic pressure was observed ［(4.93±3.37) mmHg vs. (11.47±4.61) mmHg,P＜0.05］.Six month postoperatively,right ventricular end diastolic volume measured by cardiac nuclear magnetic resonance was significantly reduced ［(139.29±18.21) mL/m2 vs. (83.03±20.0) mL/m2,P＜0.05］.At 1 year follow up,the across valve pressure difference were (20.85±4.45) mmHg calculated by the echocardiography,and the NYHA cardiac function (Ⅰ-Ⅲ:4 cases;Ⅰ-Ⅱ:10 cases) was improved 1-2 degree and the distance of 6-minute walk test were significantly increased ［(475.00±55.06) m vs. (594.23±194.51) m,P<0.05］.Meanwhile,the QRS duration decreased was also observed.The changes of the QRS duration have statistical significance after 1 and 3 months of the PPVI when compared with the baseline ［(169.93±21.34) ms vs.(159.87±24.4) ms or (160.00±27.0 ms,P<0.05］.Conclusions PPVI using home-made self-expanding pulmonary valve (Venus-P) for chronic pulmonary regurgitation has good long-term efficacy and low complication rate,and the valve is durable.