经颈静脉入路行经导管肺动脉瓣置换术治疗重度肺动脉瓣反流一例-东南大学学报医学版

经颈静脉入路行经导管肺动脉瓣置换术治疗重度肺动脉瓣反流一例

作者：丁建东¹ 徐荣丰¹ 张晓黎¹ 丁秀霞¹ 陆新健² 陆启同³ 赵振⁴ 章晓国¹ 马根山¹

单位：1. 东南大学附属中大医院心内科, 江苏南京 210009;
2. 东南大学附属中大医院麻醉科, 江苏南京 210009;
3. 东南大学附属中大医院心胸外科, 江苏南京 210009;
4. 东南大学附属中大医院放射科, 江苏南京 210009

关键词：经颈静脉入路经导管肺动脉瓣置换术肺动脉瓣反流重度

分类号：R542.54

出版年·卷·期（页码）：2023·42·第五期（759-763）

摘要：

先天性心脏病(CHD)患者常涉及右室流出道(RVOT) 功能障碍。外科跨瓣环RVOT补片加宽术可导致肺动脉瓣狭窄或反流,进而导致右心功能障碍、心律失常。经导管肺动脉瓣置换术(TPVR)可治疗RVOT功能障碍。Venus P-Valve作为中国及欧洲首个获批上市的自膨胀式TPVR产品,更适合中国人群的疾病特征。股静脉为常用入路,但在下腔静脉闭塞或髂股静脉弯曲/阻塞时,难以经股静脉入路,手术难度增大。作者报告国内首例经颈静脉入路的Venus P-Valve治疗病例(由于下腔静脉变异,直接延续奇静脉汇到上腔静脉)。

Congenital heart diseases(CHD)that involve the right ventricular outflow tract(RVOT) dysfunction are common. Surgical repair involves early relief of RVOT obstruction, which typically results in pulmonary stenosis or regurgitation and may ultimately lead to RV failure and dysrhythmias. Transcatheter pulmonary valve replacement(TPVR) is now available to treat certain patients with RVOT dysfunction.Venus P-Valve(Venus MedTech Inc., Hangzhou, China), as the first self-expansive TPVR product approved for marketing in China and Europe, is more suitable for the disease characteristics of Chinese people.The procedure is carried out almost exclusively via the transfemoral approach. However, in some patients transfemoral delivery of Venus P-valve is not technically feasible(e.g., occluded inferior vena cava or tortuous/obstructive iliofemoral venous anatomy).The technical considerations and challenges of the Venus P-valve procedure are amplified when an alternate route is considered. We describe a successful case of Venus P-valve performed via the right internal jugular approach in a patient due to interruption of the inferior vena cava with azygos vein dilation.

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