Page 557 - 先天性心脏病的导管术：从婴幼儿期到成人期

42 肺动脉瓣位置的 Melody 瓣膜植入 539

们可能会也可能不会导致瓣膜功能障碍，但应当采取相应的外科或药物管理策略 [15] 。
 血管通路并发症：也见于其他导管介入手术。在超声引导下穿刺股动脉或股
静脉来获得血管通路，尤其是对于之前曾经此入路做过介入手术的患者特别有用。在
急性股静脉出血时，使用导丝和顺应性球囊进入对侧血管，然后交叉，可暂停血流通过，

从而止血或为手术评估争取时间。也可进行血管造影来评估血管和出血点。
 据报道，Melody 瓣膜植入后 48 小时的死亡率、再手术率或再介入率约每人每
年 4.2% [6,16] 。美国 Melody 瓣膜试验性器械豁免试验报告了 5 年免于干预率为 76.4%，
移植率为 92%。目前正在进行进一步的长期评估。

参考文献

[1] Stout KK, et al. 2018 AHA/ACC guideline for the management of adults with con-
genital heart disease: a report of the American College of Cardiology/American
Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol.

2019;73(12):e81-e192.
[2] Baumgartner H, et al. ESC guidelines for the management of grown-up congenital heart
disease (new version 2010). Eur Heart J. 2010;31(23):2915-57.
[3] Martin MH, et al. Safety and feasibility of melody transcatheter pulmonary valve re-

placement in the native right ventricular outflow tract: a multicenter pediatric heart net-
work scholar study. JACC Cardiovasc Interv. 2018;11(16):1642-50.
[4] Shahanavaz S, et al. Transcatheter pulmonary valve replacement with the melody valve
in small diameter expandable right ventricular outflow tract conduits. JACC Cardiovasc

Interv. 2018;11(6):554-64.
[5] Cabalka AK, et al. Transcatheter pulmonary valve replacement using the melody valve
for treatment of dysfunctional surgical bioprostheses: a multicenter study. J Thorac Car-
diovasc Surg. 2018;155(4):1712-24. e1

[6] Nordmeyer J, et al. Acute and midterm outcomes of the post-approval MELODY reg-
istry: a multicentre registry of transcatheter pulmonary valve implantation. Eur Heart J.
2019;40(27):2255-64.
[7] McElhinney DB, et al. Short- and medium-term outcomes after transcatheter pulmo-

nary valve placement in the expanded multicenter US melody valve trial. Circulation.
2010;122(5):507-16.