RAZVOJ INTERVENTNE DIJAGNOSTIKE U REFERENTNOM CENTRU ZA PEDIJATRIJSKU KARDIOLOGIJU RH – RETROSPEKTIVNA STUDIJA 1996–2009.

Ivan Malčić, Hrvoje Kniewald, Dalibor Šarić, Zdravka Gjergja, Andrea Dasović-Buljević, Darko Anić, Dražen Belina, Višnja Ivančan, Marija Vidaković

Cilj našeg rada jest prikazati porast broja intervencijskih kateterizacija srca u zadnjih 14 godina u Referentnom centru za pedijatrijsku kardiologiju RH u odnosu na broj dijagnostičkih kateterizacija. Od siječnja 1996. do prosinca 2009. godine u našem je Centru invazivnoj dijagnostici podvrgnuto 2379-ero djece, 51% muške i 49% ženske, sa srednjom dobi u trenutku invazivne dijagnostike 4,1±3,8 godina (1 dan – 20,5 godina). U tom je razdoblju kod ukupno 22,27% (2379/530) djece učinjen neki interventni zahvat na srcu. Broj se interventnih kateterizacija godišnje povećavao od 20/160 (12,5%) 1996. do 60/182 (32,9%) 2007. godine. Neke su interventne metode uvedene prije 1996. godine (balonska atrioseptostomija po Rashkindu, dilatacija pulmonalne stenoze, biopsija miokarda), a ostale su uvedene kako slijedi: dilatacija kritične aortne stenoze u novorođenčeta, kao i aortne stenoze u veće djece od 1996. godine, transkatetersko zatvaranje Botallova duktusa od 1997. godine, transkatetersko zatvaranje defekta interatrijskog septuma od 2000. godine i balonska dilatacija nativne koarktacije i rekoarktacije od 2003. godine. Od 530 interventnih kateterizacija u studiranom razdoblju bilo je 140 atrioseptostomija (26,4%), 80 dilatacija pulmonalne valvule (15,1%), 36 dilatacija aortne valvule u veće djece (6,8%), 9 dilatacija kritične aortne stenoze (1,7%), 58 dilatacija koarktacije (10,9%) – od čega 32 nativne i 26 rekoarktacija, 133 (25,1%) zatvaranja Botallova duktusa (4 PFM spiralom, 68 Cookovom spiralom i 61 Amplatzerovim kišobranom). Od 2000. godine defekt interatrijskog septuma tipa ostium secundum zatvorili smo u 37 bolesnika, od čega u 14 bolesnika Cardioseal-STARflex sustavom (37,83), a u 23 bolesnika Amplatzerovim sustavom (62,16%). Biopsiju miokarda radili smo u 37 bolesnika (7%) od čega kod petorice dva puta, a kod svake smo biopsije izvadili 4–5 uzoraka endomiokarda (većinom iz lijeve klijetke). Hi²-testom utvrdili smo stalni trend porasta broja kateterizacija u odnosu na prosječan broj (p<0,05) osim za 1997. i 1998. godinu kada je značajno niži od prosjeka. Utvrđen je pozitivan trend porasta broja interventnih kateterizacija (p<0,005). Nađeno je da se udio interventnih prema dijagnostičkim kateterizacijama od 1996. do 2009. statistički značajno povećao (p<0,05). Zaključujemo da je u promatranom razdoblju vidljiv blag porast ukupnog broja kateterizacija te intenzivniji porast broja interventnih kateterizacija, osobito nakon 1999. godine.

The goal of our study was to show an increase in the number of interventional heart catheterisations in the last 14 years in the Referral Centre for Pediatric Cardiology of the Republic of Croatia. From January 1996 to December 2009 2379 children (51% male and 49% female) underwent invasive diagnostic procedures (mean age 4.1+3.8 years, range 1 day–20.5 years). In that period in 22.27% (2379/530) of the children a certain interventional procedure was performed. The number of interventional catheterisations increased from 20/160 (12.5%) in 1996 to 70/224 (31.25%) in 2009. Some interventional procedures were introduced before 1996 (Rashkind BAS, dilatation of pulmonary valve stenosis and myocardial biopsy), while other methods were introduced in the following order: dilatation of critical aortic stenosis in newborns and other ages from 1996, ductus Bottali closure from 1997, interatrial septal defect closure from 2000, native coarctation and recoarctation of the aorta from 2003. Of 530 interventional catheterisations involved in the study during the period of 14 years, there were 140 atrioseptostomias (26.4%), 80 pulmonary valve dilatations (15.1%), 58 aortic valve dilatations in older children (6.8%), 9 dilatations of critical aortic stenosis (1.7%), 58 dilatations of coarctation (10.9%) (of which 32 native and 26 recoarctations), 133 ductus Botalli closures (25.1%) (4 with PFM coils, 68 with Cook coils and 61 with Amplatzer Duct occluder). From 2000 interatrial septal defects were closed in 37 patients, 14 of which were closed with Cardioseal-STARflex system (37.84%) and 23 with Amplatzer device (62.16%). Myocardial biopsy was performed in 37 patients (7%) with 4–5 endomyocardial samples per patient (mainly from the left ventricle) so that we had 120 heart samples in total for further analysis. Hi²-test determined a constant rise in catheterisations in relation to the mean number (p<0.05) except for the years 1997 and 1998 when it was significantly lower than the average. A positive trend in the increase of interventional catheterisations was determined (p<0.005). The share of interventional catheterisations compared to diagnostic catheterisations was found to have statistically significantly increased (p<0.05) from 1996 to 2009. We conclude that in the observed period there is a slight increase in the overall number of catheterisations and a more intense increase of interventional catheterisations, particularly after 1999.