Pulmoner Darlıkta Girişimsel Tedavi
Özet
Pulmoner stenoz, sağ ventrikül çıkış yolunda pulmoner kapak, kapak anülüsü veya pulmoner arterleri içerebilen bir obstrüksiyonla karakterize edilen doğuştan kalp anomalisi olarak tanımlanır. Vakaların %7 ila %12'sinde izole olarak görülmesine rağmen, %25 ila %30'unda Fallot tetralojisi gibi diğer konjenital kalp defektleri ile daha sık ilişkilidir. Obstrüksiyonun derecesine ve kalbin telafi kapasitesine bağlı olarak, orta ila şiddetli stenozu olan bireylerde eforla ortaya çıkan dispne ve yorgunluk gibi semptomatik belirtiler genellikle gözlenir. Tanı öncelikle ekokardiyografi ile konulur, ancak girişimsel prosedürler için değerlendirilen hastalarda kardiyak bilgisayarlı tomografi (CCT) ve kardiyak manyetik rezonans görüntüleme (CMR) sıkça kullanılmaktadır. Tedavi yaklaşımı, obstrüksiyonun şiddeti ve kapak anatomik özelliklerine göre değişiklik gösterir.
Balon pulmoner valvüloplasti (BPV), ciddi kapak stenozu vakalarında açık kalp cerrahisi gereksinimini önemli ölçüde azaltmış olsa da, perkütan tekniklerin uygun olmadığı durumlarda cerrahi müdahale hala gerekli olmaktadır.
Pulmonary stenosis is a congenital cardiac anomaly characterized by obstruction within the right ventricular outflow tract, which may involve the pulmonary valve, annulus, or the pulmonary arteries. Although it occurs in isolation in 7% to 12% of cases, it is more frequently associated with other congenital heart defects, such as tetralogy of Fallot, in 25% to 30% of patients. Symptomatic manifestations, including exertional dyspnea and fatigue, are generally observed in individuals with moderate to severe stenosis, contingent on the extent of obstruction and the compensatory capacity of the heart. Diagnosis is primarily achieved through echocardiography, with cardiac computed tomography (CCT) and cardiac magnetic resonance imaging (CMR) frequently employed in patients being evaluated for interventional procedures. The therapeutic approach varies according to the severity of the obstruction and the anatomical characteristics of the valve.
While balloon pulmonary valvuloplasty (BPV) has significantly reduced the necessity for open-heart surgery in cases of severe valvular stenosis, surgical intervention remains indicated when percutaneous techniques are not feasible.
Referanslar
Gikonyo BM, Lucas RV, Edwards JE. Anatomic features of congenital pulmonary valvar stenosis. Pediatr Cardiol. 1987;8:109–16.
Cuypers JA, Witsenburg M, van der Linde D, Roos‐Hesselink JW. Pulmonary stenosis: update on diagnosis and therapeutic options. Heart. 2013;99(5):339‐347.
Kan JS, White RI, Mitchell SE, Gardner TJ. Percutaneous balloon valvuloplasty: a new method for treating congenital pulmonary‐valve stenosis. N Engl J Med. 1982;307(9):540‐542.
Grüntzig A. Die perkutane rekanalisation chronischer arterieller-verschisse (Dotter-Prinzip) mit einem doppellumigen dilatations-katheter. Röfo. 1976;124(1):80–86. doi: 10.1055/s-0029-1230286.
Grüntzig A., Kuhlmann V., Vetter W., Lutolf V., Meier B., Siegenthaler W. Treatment of renovascular hypertension with percutaneous transluminal dilatation of a renal artery stenosis. Lancet. 1978;1(8068):801–802. doi: 10.1016/s0140-6736(78)93000-3.
Grüntzig A. Transluminal dilatation of coronary artery stenosis. Lancet. 1978;1(8058):263. doi: 10.1016/s0140-6736(78)90500-7.
Singer M.I., Rowen M., Dorsey T.J. Transluminal aortic balloon angioplasty for coarctation of the aorta in the newborn. Am Heart J. 1982;103(1):131–132. doi: 10.1016/0002-8703(82)90539-7.
Sperling D.R., Dorsey T.J., Rowen M., Gazzaniga A.B. Percutaneous transluminal angioplasty of congenital coarctation of the aorta. Am J Cardiol. 1983;51(3):562–564. doi: 10.1016/s0002-9149(83)80097-6.
Kan J.S., White R.J., Jr., Mitchell S.E., Gardner T.J. Percutaneous balloon valvuloplasty: a new method for treating congenital pulmonary valve stenosis. N Engl J Med. 1982; 397(9): 540–2. doi: 10.1056/NEJM198208263070907.
Nishimura RA, Otto CM, Bonow RO, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63(22): e57-185.
Baumgartner H, Hung J, Bermejo J, et al. American Society of Echocardiography. European Association of Echocardiography. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009; 22(1):1-23; quiz 101-2.
Baumgartner H, Bonhoeffer P, De Groot NM, et al. Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC). Association for European Paediatric Cardiology (AEPC). ESC Committee for Practice Guidelines (CPG). ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J. 2010; 31(23): 2915-57.
Kutty S, Rathod RH, Danford DA, Celermajer DS. Role of imaging in the evaluation of single ventricle with the Fontan palliation. Heart. 2016; 102(3): 174-83.
Yin D, Wu X, Xiang P, et al. Outcomes of percutaneous balloon pulmonary valvuloplasty in congenital pulmonary valve stenosis. Clin Case Rep. 2021; 9(9): e04705.
Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008; 118(23): e714-833.
Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 139: e743-5.
Baumgartner H, Bonhoeffer P, De Groot NM, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31: 2934-6.
Ünal N, Akçoral A, Aydın A, Hüdaoğlu S, Meşe T, Yunus Ş. Ağır ve orta derecede pulmoner valvüler darlıklarda balon valvüloplasti uygulanması. Türk Girişimsel Kardiyoloji Derg 1997; 1: 54-5.
Sushma K.S., Shaıkh S. Anaesthetic management of pulmonary stenosis already treated with pulmonary balloon valvuloplasty. Journal of Clinical and Diagnostic Research 2014; 8(1): 193-4.
Talukder F., Hongxin L., Fei L. et al. Percutaneous balloon valvuloplasty of pulmonary valve stenosis: state of the art and future prospects. International Surgery Journal 2020; 7(2): 609-616.
Yadav S. K. The diagnosis and treatment of pulmonary valve stenosis in children. Asian Journal of Medical Sciences 2015; 6(6): 1-5.
Talsmo M, Witsenburg M, Rahmer J, et al. Determinants for outcome of balloon valvuloplasty for severe puımonary stenosis in neonates and infants up to six months age. Am J Cardiol 1993; 71: 246-8
Shaath G, Al Mutairi M, Tamimi O, Alakhfash A, Abolfotouh M, Alhabshan F. Predictors of reintervention in neonates with critical pulmonary stenosis or pulmonary atresia with intact ventricular septum. Catheter Cardiovasc Interv. 2012; 79(4): 659-64.
Referanslar
Gikonyo BM, Lucas RV, Edwards JE. Anatomic features of congenital pulmonary valvar stenosis. Pediatr Cardiol. 1987;8:109–16.
Cuypers JA, Witsenburg M, van der Linde D, Roos‐Hesselink JW. Pulmonary stenosis: update on diagnosis and therapeutic options. Heart. 2013;99(5):339‐347.
Kan JS, White RI, Mitchell SE, Gardner TJ. Percutaneous balloon valvuloplasty: a new method for treating congenital pulmonary‐valve stenosis. N Engl J Med. 1982;307(9):540‐542.
Grüntzig A. Die perkutane rekanalisation chronischer arterieller-verschisse (Dotter-Prinzip) mit einem doppellumigen dilatations-katheter. Röfo. 1976;124(1):80–86. doi: 10.1055/s-0029-1230286.
Grüntzig A., Kuhlmann V., Vetter W., Lutolf V., Meier B., Siegenthaler W. Treatment of renovascular hypertension with percutaneous transluminal dilatation of a renal artery stenosis. Lancet. 1978;1(8068):801–802. doi: 10.1016/s0140-6736(78)93000-3.
Grüntzig A. Transluminal dilatation of coronary artery stenosis. Lancet. 1978;1(8058):263. doi: 10.1016/s0140-6736(78)90500-7.
Singer M.I., Rowen M., Dorsey T.J. Transluminal aortic balloon angioplasty for coarctation of the aorta in the newborn. Am Heart J. 1982;103(1):131–132. doi: 10.1016/0002-8703(82)90539-7.
Sperling D.R., Dorsey T.J., Rowen M., Gazzaniga A.B. Percutaneous transluminal angioplasty of congenital coarctation of the aorta. Am J Cardiol. 1983;51(3):562–564. doi: 10.1016/s0002-9149(83)80097-6.
Kan J.S., White R.J., Jr., Mitchell S.E., Gardner T.J. Percutaneous balloon valvuloplasty: a new method for treating congenital pulmonary valve stenosis. N Engl J Med. 1982; 397(9): 540–2. doi: 10.1056/NEJM198208263070907.
Nishimura RA, Otto CM, Bonow RO, et al. American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014; 63(22): e57-185.
Baumgartner H, Hung J, Bermejo J, et al. American Society of Echocardiography. European Association of Echocardiography. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. J Am Soc Echocardiogr. 2009; 22(1):1-23; quiz 101-2.
Baumgartner H, Bonhoeffer P, De Groot NM, et al. Task Force on the Management of Grown-up Congenital Heart Disease of the European Society of Cardiology (ESC). Association for European Paediatric Cardiology (AEPC). ESC Committee for Practice Guidelines (CPG). ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J. 2010; 31(23): 2915-57.
Kutty S, Rathod RH, Danford DA, Celermajer DS. Role of imaging in the evaluation of single ventricle with the Fontan palliation. Heart. 2016; 102(3): 174-83.
Yin D, Wu X, Xiang P, et al. Outcomes of percutaneous balloon pulmonary valvuloplasty in congenital pulmonary valve stenosis. Clin Case Rep. 2021; 9(9): e04705.
Warnes CA, Williams RG, Bashore TM, et al. ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines on the management of adults with congenital heart disease). Circulation. 2008; 118(23): e714-833.
Stout KK, Daniels CJ, Aboulhosn JA, et al. 2018 AHA/ACC Guideline for the Management of Adults With Congenital Heart Disease: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 139: e743-5.
Baumgartner H, Bonhoeffer P, De Groot NM, et al. ESC Guidelines for the management of grown-up congenital heart disease (new version 2010). Eur Heart J 2010; 31: 2934-6.
Ünal N, Akçoral A, Aydın A, Hüdaoğlu S, Meşe T, Yunus Ş. Ağır ve orta derecede pulmoner valvüler darlıklarda balon valvüloplasti uygulanması. Türk Girişimsel Kardiyoloji Derg 1997; 1: 54-5.
Sushma K.S., Shaıkh S. Anaesthetic management of pulmonary stenosis already treated with pulmonary balloon valvuloplasty. Journal of Clinical and Diagnostic Research 2014; 8(1): 193-4.
Talukder F., Hongxin L., Fei L. et al. Percutaneous balloon valvuloplasty of pulmonary valve stenosis: state of the art and future prospects. International Surgery Journal 2020; 7(2): 609-616.
Yadav S. K. The diagnosis and treatment of pulmonary valve stenosis in children. Asian Journal of Medical Sciences 2015; 6(6): 1-5.
Talsmo M, Witsenburg M, Rahmer J, et al. Determinants for outcome of balloon valvuloplasty for severe puımonary stenosis in neonates and infants up to six months age. Am J Cardiol 1993; 71: 246-8
Shaath G, Al Mutairi M, Tamimi O, Alakhfash A, Abolfotouh M, Alhabshan F. Predictors of reintervention in neonates with critical pulmonary stenosis or pulmonary atresia with intact ventricular septum. Catheter Cardiovasc Interv. 2012; 79(4): 659-64.
