Therrien J, Thorne S A, Wright A, Kilner P J, Somerville J
Jane Somerville Grown Up Congenital Heart Unit, Royal Brompton and Harefield NHS Trust, National Heart and Lung Institute, Imperial College School of Medicine, London, United Kingdom.
J Am Coll Cardiol. 2000 Mar 15;35(4):997-1002. doi: 10.1016/s0735-1097(99)00653-1.
The study was done to determine the most "cost-effective" approach to follow adults after repair of coarctation of the aorta.
Recoarctation and/or aneurysm formation following surgical repair or angioplasty for coarctation of the aorta carry a significant morbidity and mortality. Various screening tests to detect such complications are used, but little is known of their sensitivities and specificities; as a consequence, the most "cost-effective" approach to follow such patients is undefined.
Retrospective analysis was done on the sensitivity and specificity of symptomatology, physical examination, electrocardiogram, chest radiograph, exercise testing and transthoracic echocardiography to detect recoarctation and/or aneurysm formation in 84 adult patients following surgical repair or angioplasty of coarctation of the aorta, using magnetic resonance imaging (MRI) as the gold standard test.
Echocardiography had the highest sensitivity in detecting recoarctation (87%) and chest radiograph the highest sensitivity in detecting aneurysm formation (67%). Combined clinical visit and echocardiography had a high sensitivity for diagnosing recoarctation and/or aneurysm formation (97%), but performing a clinical visit and an MRI on every patient without any prior screening test emerged as the most "cost-effective" strategy.
The most "cost-effective" approach to diagnose complications at the site of repair in patients after surgical repair or balloon angioplasty of coarctation of the aorta appears to be the combination of clinical assessment and MRI scan on every patient. If MRI resources are scant, performing a clinical assessment plus a transthoracic echocardiography and an MRI on patients with positive results is an acceptable alternative.
本研究旨在确定主动脉缩窄修复术后随访成人患者的最“经济有效”方法。
主动脉缩窄手术修复或血管成形术后再缩窄和/或动脉瘤形成会带来显著的发病率和死亡率。人们使用了各种筛查试验来检测此类并发症，但对其敏感性和特异性了解甚少；因此，随访此类患者的最“经济有效”方法尚不明确。
对84例接受主动脉缩窄手术修复或血管成形术后的成年患者，以磁共振成像（MRI）作为金标准试验，回顾性分析症状学、体格检查、心电图、胸部X线片、运动试验和经胸超声心动图检测再缩窄和/或动脉瘤形成的敏感性和特异性。
超声心动图检测再缩窄的敏感性最高（87%），胸部X线片检测动脉瘤形成的敏感性最高（67%）。临床检查与超声心动图联合对诊断再缩窄和/或动脉瘤形成具有较高的敏感性（97%），但在没有任何预先筛查试验的情况下，对每位患者进行临床检查和MRI检查是最“经济有效”的策略。
对于主动脉缩窄手术修复或球囊血管成形术后患者，诊断修复部位并发症的最“经济有效”方法似乎是对每位患者进行临床评估和MRI扫描。如果MRI资源不足，对检查结果呈阳性的患者进行临床评估加经胸超声心动图检查以及MRI检查是一种可接受的替代方法。
