Hjortdal Vibeke E, Khambadkone Sachin, de Leval Marc R, Tsang Victor T
Cardiothoracic Unit, Great Ormond Street Hospital for Children National Health Service Trust, London, United Kingdom.
Ann Thorac Surg. 2003 Aug;76(2):572-5. doi: 10.1016/s0003-4975(03)00431-4.
Spinal cord perfusion is predominantly from the anterior spinal artery, which arises from the vertebral arteries by way of the subclavian arteries. Anomalous origin of the right subclavian artery and coarctation of the aorta is considered to be an increased risk factor for spinal cord damage, possibly because of the minimal collateral circulation during aortic clamping. The aim of this study is to review 5 consecutive cases of neonatal aortic coarctation with ARSA.
Five neonates (0.8 to 4.6 kg) underwent operation between July 1999 and December 2000 with resection of the coarctation and end-to-end anastomosis. Both subclavian arteries (n = 5) and left carotid artery (n = 4) were clamped, leaving the right carotid artery as the sole provider of perfusion for the spinal cord.
Despite clamping of both subclavian arteries, right radial artery pressure was measurable in 4 of the 5 cases. Aortic cross-clamp times varied from 12 to 26 minutes at a core temperature of 34 degrees to 35 degrees C. There was no operative mortality. None of the neonates developed any major neurologic sequelae.
When clamping the two subclavian arteries during coarctation repair, the spinal artery is left with collateral blood flow that can theoretically originate from the carotid arteries through the circle of Willis and retrogradely down the vertebral arteries. The presence of such collateral circulation was documented as recordable blood pressure in the right radial artery during surgical repair.
脊髓灌注主要来自脊髓前动脉，该动脉通过锁骨下动脉由椎动脉发出。右锁骨下动脉异常起源和主动脉缩窄被认为是脊髓损伤的一个增加的危险因素，可能是因为在主动脉钳夹期间侧支循环极少。本研究的目的是回顾5例连续的患有迷走右锁骨下动脉（ARSA）的新生儿主动脉缩窄病例。
5例新生儿（体重0.8至4.6千克）于1999年7月至2000年12月期间接受了手术，进行缩窄切除和端端吻合。双侧锁骨下动脉（n = 5）和左侧颈动脉（n = 4）被钳夹，仅留右侧颈动脉作为脊髓灌注的唯一供血来源。
尽管双侧锁骨下动脉被钳夹，但5例中有4例可测量到右桡动脉压力。在核心温度为34℃至35℃时，主动脉阻断时间从12分钟到26分钟不等。无手术死亡病例。没有新生儿出现任何严重的神经后遗症。
在缩窄修复过程中钳夹双侧锁骨下动脉时，脊髓动脉仍有侧支血流，理论上该血流可通过Willis环从颈动脉起源并逆行至椎动脉。在手术修复期间，这种侧支循环的存在表现为右桡动脉可记录到血压。
