Objective Investigate the role of “Perinatal integrated intervention model” in Three Level Prevention of critical pulmonary valve stenosis.
Methods Twenty-one infants (age ≤ 60 days at operating day) suffered from critical pulmonary valve stenosis (CPS) were enrolled in this case-control-study with written informed consent. In which there were 7 cases of prenatal diagnosis in our prenatal diagnosis centre (prenatal group, Pre) and 14 cases of referral (Postpartum group, according to the time of operation less or more than 28 days, postpartum group was divided into two groups, postpartum group A and postpartum group B, which were named Post A and Post B). To Pre-group, the integrative interventional protocol was cautiously made by the consultative specialists, including intrauterine diagnosis, perinatal care and urgent percutaneous balloon pulmonary valvuloplasty (PBPV) soon after birth. To Post-group, emergency PBPV was preformed after the referral. Tei index of right ventricular and Pressure-gradient (PG) between right ventricular and pulmonary artery were measured before and at different time points with one year after PBPV.
Results ➀ Seven cases of critical and extremely critical PS were diagnosed by foetal echocardiogram and confirmed by echocardiography after birth during April 2007 to December 2011, and the values of SpO2 ranged from 82%-92%, which was named Pre group. PBPV was successfully preformed within 3–6 days after birth. The values of pre- and post- procedure PG were 86.34 ± 8.77 mmHg and 31.43 ± 8.46 mmHg respectively. Preoperative RV Tei-index was 0.68 ± 0.05, decreased rapidly after procedure, and recovered to normal one month after procedure. Only one case revealed restenosis seven months after procedure and repeated PBPV. ➁ 14 cases of referral (6 cases in Post A group and 8 cases in Post B group), the values of SpO2 ranged from 83%-91%, and the operating time was 10 –57 days after birth. Increased preoperative RV pressure and Tei-index were obviously decreased significantly post-procedure. Only one case revealed restenosis nine months after procedure and repeated PBPV.
Conclusions Compared with the referral cases, preoperative condition and postoperative right ventricular function were better, as well as the time of hypoxic exposure was shorter in the infants of Pre group. “Perinatal integrated intervention model” with multidisciplinary cooperation is an efficient strategy in Three Level Prevention to infants suffered from CPS, and can significantly improve the prognosis and quality of life in this patient population.