Mizuno A, Nakamura Y, Takayasu H, Saitoh H, Matsui M
Department of Cardiovascular Surgery, Saitama Children's Medical Center.
Kyobu Geka. 1992 Oct;45(11):956-9.
Repair of coarctation of the aorta was performed in 37 cases (31 patients, 6 patients of reoperation) ranging from 4 days old to 15 years old. Subclavian flap repair were performed in 15, resection and end-to-end anastomosis in 14, patch aortoplasty in 6, and interposition graft in 2. Subclavian flap angioplasty or end-to-end anastomosis is considered the procedure of choice in infants. However, the incidence of reoperation significantly increased in patients younger than age one month at initial subclavian flap repair. Mechanism of recurrent coarctation may be possibly related to retention of abnormal tissue, which is possibly ductal and/or intimal shelf, with the potential for proliferation and luminal narrowing. We suggest that in applicable case end-to-end anastomosis rather than subclavian flap angioplasty may be the surgical technique of choice in infants less than one month of age, and the most common reoperation technique was patch aortoplasty in re-stenosed cases.
对37例(31例患者,6例再次手术患者)年龄从4天至15岁的主动脉缩窄患者进行了修复手术。其中15例行锁骨下动脉瓣修复术,14例行切除端端吻合术,6例行补片主动脉成形术,2例行血管移植术。锁骨下动脉瓣血管成形术或端端吻合术被认为是婴儿的首选手术方式。然而,初次行锁骨下动脉瓣修复术时年龄小于1个月的患者再次手术的发生率显著增加。再发缩窄的机制可能与异常组织残留有关,这些异常组织可能是导管和/或内膜架,有增殖和管腔狭窄的可能。我们建议,在适用的病例中,对于年龄小于1个月的婴儿,端端吻合术而非锁骨下动脉瓣血管成形术可能是首选的手术技术,而再狭窄病例中最常见的再次手术技术是补片主动脉成形术。