Li F, Zhou A, Gao W, Wang R, Yu Z, Huang M, Yang J
Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Second Medical University, Shanghai 200127, China.
Chin Med J (Engl). 2001 May;114(5):459-61.
To evaluate the efficiency of percutaneous balloon angioplasty of coarctation of the aorta in children and discuss its risk factors that can lead to poor long-term results.
From September 1987 to August 1999, 24 patients underwent 27 balloon angioplasty procedures for native or recurrent coarctation of the aorta at our institution. There were 19 patients with discrete (membranous) coarctation, 4 patients with long-segment and aortic arch hypoplasia, and 1 patient with postoperative recurrence. The balloon diameter was chosen not to exceed the diameter of the aorta proximal to the stenotic site (11.06 +/- 2.80 mm vs 11.78 +/- 3.18 mm), with the chosen diameter two to four times that of the stenotic segment (2.57 +/- 0.68 times). The patients have been followed up for half to twelve years (mean 6.2 +/- 2.8 years). Satisfactory result was defined as a reduction in the pressure gradient across the site of coarctation to < or = 20 mm Hg.
The systolic pressure gradient across the coarctation site decreased from 48.17 +/- 14.68 mm Hg to 14.96 +/- 13.12 mm Hg (P < 0.01) and the diameter of the coarctation site increased from 4.66 +/- 2.43 mm to 8.80 +/- 3.32 mm (P < 0.01). Immediate satisfactory results were obtained in 19 patients (79%). Of the 5 patients with unsatisfactory results, 4 had aortic arch hypoplasia and 1 had membranous coarctation. Of the 19 patients with satisfactory results, 18 patients had membranous coarctation and 1 patient had recurrent postoperative coarctation. No aneurysm and other complications had occurred in any patients at the follow-ups.
Percutaneous balloon angioplasty is an effective treatment alternative to surgery in most patients with recurrent postoperative or native membranous coarctation of the aorta. It should not be recommended for the coarctation of aortic arch hypoplasia.
评估儿童主动脉缩窄经皮球囊血管成形术的疗效，并探讨可能导致长期预后不良的危险因素。
1987年9月至1999年8月，我院24例患者接受了27次针对原发性或复发性主动脉缩窄的球囊血管成形术。其中19例为局限性（膜性）缩窄，4例为长段型伴主动脉弓发育不全，1例为术后复发。选择的球囊直径不超过狭窄部位近端主动脉直径（11.06±2.80mm对11.78±3.18mm），所选直径为狭窄段直径的2至4倍（2.57±0.68倍）。患者随访半年至12年（平均6.2±2.8年）。满意结果定义为缩窄部位的压力阶差降至≤20mmHg。
缩窄部位的收缩期压力阶差从48.17±14.68mmHg降至14.96±13.12mmHg（P<0.01），缩窄部位直径从4.66±2.43mm增加至8.80±3.32mm（P<0.01）。19例患者（79%）获得即刻满意结果。5例结果不满意的患者中，4例有主动脉弓发育不全，1例为膜性缩窄。19例结果满意的患者中，18例为膜性缩窄，1例为术后复发性缩窄。随访期间所有患者均未发生动脉瘤及其他并发症。
经皮球囊血管成形术是大多数术后复发或原发性膜性主动脉缩窄患者手术治疗的有效替代方法。对于主动脉弓发育不全的缩窄不建议采用该方法。
