Wood Alfred E, Javadpour Hossein, Duff Desmond, Oslizlok Paul, Walsh Kevin
Department of Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland.
Ann Thorac Surg. 2004 Apr;77(4):1353-7; discussion 1357-8. doi: 10.1016/j.athoracsur.2003.07.045.
Recurrent coarctation is an ever-present complication of surgical treatment of coarctation of aorta (CoA) among infants. No single operation appears to have a clear superiority.
From January 1, 1986, to June 30, 2002, a consecutive series of 181 patients less than 1 year of age (range 1 to 300 days, median 13.5 days) were referred for CoA repair. Neonates accounted for 135 patients, and hypoplastic arch (less than 1 mm/kg plus 1) was present in 107 infants. Coarctation of aorta was simple (group 1) in 71 patients; complicated by ventricular septal defect (group 2) in 62; and complicated by complex congenital heart disease (group 3) in 48. All patients were assessed by right arm/left leg Dynamap pressures and routine follow-up was performed by the cardiologists. Follow-up was complete in all patients (range 6 months to 16 years, median 7.5 years).
The overall hospital/30-day mortality was 0.5% (group 1 = 0, group 2 = 0, group 3 = 1 [2.0%]). Complications other than recoarctation occurred in 5 patients (2.7%). Late mortality occurred in 15 (11 at intracardiac repair). Recoarctation, ie, a gradient of more than 20 mm Hg, occurred in 4 patients (2.2%). All 4 patients were noted to have a gradient of more than 10 mm Hg (right arm/left leg) postoperatively and as such had residual coarctation. All 4 were successfully treated by balloon aortoplasty.
Extended arch aortoplasty in association with ductal and coarctation excision provides excellent coarctation repair with a low incidence of recoarctation. Recoarctation occurred only in proximal aortic arch hypoplasia or low birth weight. Balloon aortoplasty easily and effectively relieved the recoarctation in all cases.
在婴儿主动脉缩窄（CoA）的外科治疗中，复发性主动脉缩窄是一种一直存在的并发症。没有一种单一的手术方法似乎具有明显的优势。
从1986年1月1日至2002年6月30日，连续收治181例年龄小于1岁（范围1至300天，中位数13.5天）的CoA修复患者。新生儿有135例，107例婴儿存在主动脉弓发育不良（小于1mm/kg加1）。71例患者的主动脉缩窄为单纯型（第1组）；62例合并室间隔缺损（第2组）；48例合并复杂先天性心脏病（第3组）。所有患者均通过右臂/左腿Dynamap血压进行评估，心脏病专家进行常规随访。所有患者随访均完整（范围6个月至16年，中位数7.5年）。
总体住院/30天死亡率为0.5%（第1组 = 0，第2组 = 0，第3组 = 1 [2.0%]）。除再缩窄外的并发症发生在5例患者（2.7%）。晚期死亡发生在15例（心内修复术后11例）。4例患者（2.2%）发生再缩窄，即压差超过20mmHg。所有4例患者术后均被发现右臂/左腿压差超过10mmHg，因此存在残余缩窄。所有4例均通过球囊主动脉成形术成功治疗。
扩大的主动脉弓成形术联合动脉导管和缩窄切除术可提供出色的缩窄修复，再缩窄发生率低。再缩窄仅发生在近端主动脉弓发育不良或低出生体重的情况下。球囊主动脉成形术在所有病例中均能轻松有效地缓解再缩窄。
