Prikaz novih metoda intervencijskog liječenja u Referentnom centru za pedijatrijsku kardiologiju Republike Hrvatske

Daniel Dilber, Dalibor Šarić, Dorotea Bartoniček, Marina Mihalec, Matija Bakoš, Darko Anić, Dražen Belina, Željko Đurić, Mislav Planinc

Cilj rada: prikazati nove metode intervencijskog liječenja u Referentnom centru. Bolesnici i metode: Prikazani su slučajevi od 1. srpnja 2018. do 1. srpnja 2022. u kojih je učinjena nova procedura, neovisno o dobi i spolu. U analizu su uključeni svi pacijenti kojima je učinjena nova metoda intervencijskog liječenja s prikazom podležeće anatomske/hemodinamske patologije te prikazom nove metode. Rezultati: U navedenom periodu uvedeno je pet novih perkutanih metoda, učinjenih u ukupno 34 pacijenta. Učinjeno je trinaest intervencija umetanja stenta u trinaest pacijenata s koarktacijom aorte. Srednja dob pacijenata kojima je učinjen perkutani zahvat umetanja stenta u koarktaciju aorte jest 13,4 godine. U navedenom periodu u šestero pacijenata stenoza pulmonalne grane liječena je umetanjem stenta. Od toga je troje pacijenata bilo dojenačke dobi, jedno u dobi od šesnaest mjeseci, jedno u dobi od četiri godine te jedna pacijentica u dobi od petnaest godina. U tri bolesnika učinjeno je perkutano umetanje zalistka Melody (kravlja jugularna vena integrirana u prekriveni stent), srednje dobi kod zahvata 17,3 godine. Metodom dilatacije stenta, zbog razvoja restenoze, liječili smo deset pacijenata, kod čega sedam dilatacijom prethodno umetnutog stenta u rekoarktaciju aorte, dva pacijenta dilatacijom stenta umetnutog na poziciji restenoze pulmonalnih grana te jednog dilatacijom stenta u stenotičnoj gornjoj šupljoj veni. Peta metoda koje je uvedena jest zatvaranje aortopulmonalnih kolaterala u djece s univentrikulskom cirkulacijom. Učinjena je u dvoje djece, dojenčeta u dobi od četiri mjeseca i pacijentice u dobi od tri i pol godine, a koji boluju od sindroma hipoplastičnoga lijevog srca. Svi su zahvati učinjeni uz povoljan hemodinamski rezultat, bez akutnih uz zahvat vezanih komplikacija. Zaključak: Uvođenjem novih metoda stekli smo nova znanja, poboljšali razinu dostupne skrbi u Republici Hrvatskoj (RH) te u konačnici i utjecali na smanjenje slanja složenih bolesnika u inozemstvo te tako reducirali troškove.

The aim: To present new methods of interventional treatment in the Reference Center. Patients and methods: Cases from July 1, 2018 to July 1, 2022 in which a new procedure was performed, regardless of age and gender, are presented. The analysis included all patients who underwent a new method of interventional treatment with a description of the underlying anatomical/hemodynamic pathology and a description of the new method. Results: In the mentioned period, five new percutaneous methods were introduced in a total of 34 patients. Thirteen stent insertion interventions were performed in 13 patients with coarctation of the aorta. The median age of patients who underwent percutaneous stent insertion in coarctation of the aorta was 13.4 years. During the mentioned period, in six patients, stenosis of the pulmonary branch was treated by inserting a stent. Of these, three patients were infants, one at the age of 16 months, one at the age of four years, and one patient at the age of 15 years. Percutaneous insertion of Melody valve (cow’s jugular vein integrated into a covered stent) was performed in three patients, whose average age at the procedure was 17.3 years. With the method of stent dilation, due to the development of restenosis, we treated ten patients, seven with dilation of a previously inserted stent in recoarctation of the aorta, two patients with dilation of a stent inserted at the position of restenosis of the pulmonary branches, and one with dilation of a stent in the stenotic superior caval vein. The fifth method that was introduced was the closure of aortopulmonary collaterals in children with univentricular circulation. It was performed in two children, a four-month-old infant and a three-and-a-half-year-old patient, who suffer from hypoplastic left heart syndrome. All procedures were performed with a favorable hemodynamic result, without acute procedure-related complications. Conclusion: By introducing new methods, we gained new knowledge, improved the level of available care in the Republic of Croatia, and ultimately reduced the costs of referring complex patients abroad.