evrazkarЕвразийский Кардиологический ЖурналEurasian heart journal2225-16852305-0748Евразийская ассоциация кардиологов10.38109/2225-1685-2023-4-6-15evrazkar-6421Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL PAPERSОценка развития легочного русла и результатов двухэтапной коррекции у младенцев с критической формой Тетрады ФаллоAssessment of the pulmonary arterial growth and results of two-stage repair in infants with severe form of tetralogy of Fallothttps://orcid.org/0000-0003-3870-169XМорсинаМ. Г.MorsinaM. G.

Морсина Мелине Гамлетовна, врач сердечно-сосудистый хирург кардиохирургического отделения №1

ул. Речкуновская, д. 15, г. Новосибирск 630055

Meline G. Morsina, Cardiovascular Surgeon, Cardiosurgical Department No. 1

Rechkunovskaya str, 15, Novosibirsk 630055

melinegamletovna@yandex.ruhttps://orcid.org/0000-0003-3691-2848СойновИ. А.SoynovI. A.

Сойнов Илья Александрович, к.м.н., врач сердечно-сосудистый хирург кардиохирургического отделения №1, старший научный сотрудник центра новых хирургических технологий 

ул. Речкуновская, д. 15, г. Новосибирск 630055

Ilya A. Soynov, Cand. of Sci. (Med.), Cardiovascular Surgeon, Cardiosurgical Department No. 1, Senior Researcher, Center for New Surgical TechnologiesRechkunovskaya str, 15, Novosibirsk 630055

https://orcid.org/0000-0003-3797-4899ВойтовА. В.VoitovA. V.

Войтов Алексей Викторович, к.м.н., врач сердечно-сосудистый хирург кардиохирургического отделения №1

ул. Речкуновская, д. 15, г. Новосибирск 630055

Aleksey V. Voitov, Cand. of Sci. (Med.), Cardiovascular Surgeon, Cardiosurgical Department No. 1

Rechkunovskaya str, 15, Novosibirsk 630055

https://orcid.org/0000-0002-1421-1795ПурсановМ. Г.PursanovM. G.

Пурсанов Манолис Георгиевич, д.м.н., врач рентгенэндоваскулярный хирург

4-й Добрынинский переулок, д. 1/9, Г. Москва 119049

Manolis G. Pursanov, Dr. of Sci. (Med.), X-ray Endovascular Surgeon

1/9, 4th Dobryninskiy pereulok, Moscow 119049

https://orcid.org/0000-0002-2361-5847КулябинЮ. Ю.KulyabinYu. Yu.

Кулябин Юрий Юрьевич, к.м.н., врач сердечно-сосудистый хирург кардиохирургического отделения №1

ул. Речкуновская, д. 15, г. Новосибирск 630055

Yury Yu. Kulyabin, Cand. of Sci. (Med.), Cardiovascular Surgeon, Cardiosurgical Department No. 1

Rechkunovskaya str, 15, Novosibirsk 630055

https://orcid.org/0000-0002-1763-9535НичайН. Р.NichayN. R.

Ничай Наталия Романовна, к.м.н., врач сердечно-сосудистый хирург кардиохирургического отделения врожденных пороков сердца

ул. Речкуновская, д. 15, г. Новосибирск 630055

Ул. Красный проспект, д. 52, Г. Новосибирск, 630091

Nataliya R. Nichay, Cand. of Sci. (Med.), Cardiovascular Surgeon, Cardiosurgical Department No. 1

Rechkunovskaya str, 15, Novosibirsk 630055

Krasny prospect 52, Novosibirsk 630091

https://orcid.org/0000-0003-4017-4198ГорбатыхА. В.GorbatykhA. V.

Горбатых Артем Викторович, к.м.н., заведующий НИЛ интервенционной хирургии, врач по рентгенэндоваскулярной диагностике и лечению, врач сердечно-сосудистый хирург

Ул. Аккуратова, д. 2, Г. Санкт-Петербург, 197341

Artem V. Gorbatykh, Cand. Med. Sci. (Med.), Head of Research Laboratory of Interventional Surgery, Endovascular Surgeon

Akkuratova Str. 2, Saint Petersburg 197341

https://orcid.org/0000-0003-3234-5436АрхиповА. Н.ArkhipovA. N.

Архипов Алексей Николаевич, к.м.н., врач сердечно-сосудистый хирург, заведующий кардиохирургического отделения №1, старший научный сотрудник центра новых хирургических технологий 

ул. Речкуновская, д. 15, г. Новосибирск 630055

Aleksey N. Arkhipov, Cand. Med. Sci. (Med.), Cardiovascular Surgeon, Head of the Cardiosurgical Department No.1, Senior Researcher, Center for New Surgical Technologies

Rechkunovskaya str, 15, Novosibirsk 630055

https://orcid.org/0000-0003-4625-4631Богачев-ПрокофьевА. В.Bogachev-ProkofievA. V.

Богачев-Прокофьев Александр Владимирович, д.м.н., директор института патологии кровообращения, врач сердечно-сосудистый хирург кардиохирургического отделения №3 

ул. Речкуновская, д. 15, г. Новосибирск 630055

Alexander V. Bogachev-Prokofiev, Dr. of Sci. (Med.), Chief of department circulatory pathology

Rechkunovskaya str, 15, Novosibirsk 630055

https://orcid.org/0000-0001-9818-8678ЧернявскийА. М.ChernyavskiyA. M.

Чернявский Александр Михайлович, чл.-корр. РАН, д.м.н., профессор, директор

ул. Речкуновская, д. 15, г. Новосибирск 630055

Aleksander M. Chernyavskiy, corresponding member of RAS, Dr. of Sci. (Med.), Prof., General Director

Rechkunovskaya str, 15, Novosibirsk 630055

ФГБУ «НМИЦ им. ак. Е.Н. Мешалкина» Минздрава РоссииРоссияMeshalkin National Medical Research CenterRussian FederationГБУЗ г. Москвы «Морозовская детская городская клиническая больница Департамента здравоохранения города Москвы»РоссияMorozov Children’s Municipal Clinical Hospital of the Moscow City Health DepartmentRussian FederationФГБУ «НМИЦ им. ак. Е.Н. Мешалкина» Минздрава России; ФГБОУ ВО «Новосибирский Государственный медицинский университет» Министерства здравоохранения Российской ФедерацииРоссияMeshalkin National Medical Research Center; Novosibirsk State Medical UniversityRussian FederationФГБУ »НМИЦ им. В.А. Алмазова Минздрава России»РоссияAlmazov National Medical Research CentreRussian Federation20232211202304615Copyright © Морсина М.Г., Сойнов И.А., Войтов А.В., Пурсанов М.Г., Кулябин Ю.Ю., Ничай Н.Р., Горбатых А.В., Архипов А.Н., Богачев-Прокофьев А.В., Чернявский А.М., 20232023Морсина М.Г., Сойнов И.А., Войтов А.В., Пурсанов М.Г., Кулябин Ю.Ю., Ничай Н.Р., Горбатых А.В., Архипов А.Н., Богачев-Прокофьев А.В., Чернявский А.М.Morsina M.G., Soynov I.A., Voitov A.V., Pursanov M.G., Kulyabin Y.Y., Nichay N.R., Gorbatykh A.V., Arkhipov A.N., Bogachev-Prokofiev A.V., Chernyavskiy A.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.heartj.asia/jour/article/view/6421Цель

Цель: оценить развитие легочного русла и результаты радикальной коррекции после паллиативного лечения у младенцев с критической формой тетрады Фалло.

Материалы и методы

Материалы и методы. В проспективное рандомизированное двуцентровое исследование включены младенцы с тетрадой Фалло, оперированные в период с 2019 по 2022 гг.: которым выполнялось стентирование выходного отдела правого желудочка (группа «стент», n=21) или формирование модифицированного шунта по Блэлок-Тауссиг (группа «шунт», n=21).

Результаты

Результаты. В группе стент отмечен более значимый прирост индекса Nakata в среднем с 104,2 до 208,6 мм2/м2, в то время как в группе шунт – с 107,3 до 169,4 мм2/м2 (p<0,01). По результатам смешанной модели скорость роста правой легочной артерии в группе стент 2,05*10-2 z score/день, что в 3,01 раз больше, чем в группе шунт. Скорость роста левой легочной артерии в группе стент 2,3*10-2 z score/день, что в 1,47 раз больше, чем в группе шунт. В группе стент в межэтапном периоде 1 летальный исход, обусловленный некардиальной патологией. При радикальной коррекции у 12 (60%) пациентов в группе стент и у 15 (71,4%) – в группе шунт выполнена трансаннулярная пластика пути оттока в легочную артерию (p=0,52). В оставшихся 8 (40%) случаях группы стент и 6 (28,6%) группы шунт выполнено протезирование легочной артерии. При межгрупповом сравнении длительность операции радикальной коррекции в группе стент достоверно короче (p=0,046), в то время как время окклюзии аорты (p<0,01) и искусственного кровообращения (p<0,01) достоверно меньше в группе шунт.

Выводы

Выводы. Стентирование выходного отдела правого желудочка обеспечивает стабилизацию гемодинамики и равномерный рост легочного русла в сравнении с формированием модифицированного шунта Блэлок-Тауссиг. 

Aim

Aim: assess of the pulmonary artery growth and the outcomes of complete repair after palliative treatment in infants with critical form of Tetralogy of Fallot.

Methods

Methods. This was prospective randomized two-center study (2019 to 2022). Its included infants with Tetralogy of Fallot who underwent palliation with either stenting of the right ventricular outflow tract (stent group, n=21) or modified Blalock-Taussig shunt (shunt group, n=21).

Results

Results. In the stent group Nakata index increase from median 104.2 to 208.6 mm2/m2, while in the shunt group, it increased from 107.3 to 169.4 mm2/m2 (p<0,01). Mixed model analysis showed that in stent group the right pulmonary artery growth rate was 2.05*10-2 z scores/day, which was 3.01 times higher than in the shunt group. In stent group the left pulmonary artery growth rate was 2.3*10-2 z scores/day, which was 1.47 times higher than in the shunt group. In the stent group, there was one noncardiac-related mortality during the intermediate period. Transannular patch repair of the right ventricular outflow tract was performed in 12 patients (60%) in the stent group and in 15 patients (71.4%) in the shunt group (p=0.52) during complete repair. At 8 cases (40%) in the stent group and 6 cases (28.6%) in the shunt group, pulmonary artery replacement was performed. Time to surgical repair was shorter in the stent group (p=0.046), while the aortic cross clamp time (p<0,01) and cardiopulmonary bypass time (p<0,01) were significantly shorter in the shunt group.

Conclusions

Conclusions. Right ventricular outflow tract stenting provides hemodynamic stabilization and uniform growth of the pulmonary artery compared to modified Blalock-Taussig shunt.

тетрада Фаллогипоплазия легочных артерийдвухэтапная коррекциястентирование выходного отдела правого желудочкамодифицированный шунт Блэлок-Тауссигtetralogy of Fallotpulmonary artery hypoplasiatwo-stage repairstenting of the right ventricular outflow tractmodified Blalock-Taussig shuntИсследование выполнено в рамках проекта № 22- 25-20102 (соглашение № 22-25-20102 от 22.03.2022 г. c РНФ и соглашение № р-29 от 13.03.2023 г. c Министерством науки и инновационной политики Новосибирской области).The research was carried out within the framework of project No. 22- 25-20102 (agreement No. 22-25-20102 dated 22.03.2022 with the Russian Science Foundation and agreement No. r-29 dated 13.03.2023 with the Ministry of Science and Innovation Policy of the Novosibirsk Region)ReferencesAl Habib HF, Jacobs JP, Mavroudis C, Tchervenkov CI, O’Brien SM, Mohammadi S, Jacobs ML. Contemporary patterns of management of tetralogy of Fallot: data from the Society of Thoracic Surgeons Database. 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The authors declare that there are no conflicts of interest present.