Agnoletti Gabriella, Bonnet Caroline, Bonnet Damien, Sidi Daniel, Aggoun Yacine
Service de Cardiologie Pédiatrique, Necker-Enfants Malades, Paris, France.
Cardiol Young. 2005 Jun;15(3):245-50. doi: 10.1017/S1047951105000521.
Primary implantation of stents is an accepted technique for treating aortic recoarctation, albeit that the effects of stenting on pressure profiles, carotid mechanical properties, intimal medial thickness, and reflection of the pulse wave have not been systematically investigated.
Over the period from 1 January, 1999, to 31 December, 2002, we implanted stents to relieve aortic recoarctation in 15 patients, with a median age of 17 years, and a range from 7 to 29 years, with a median weight of 56 kilograms, ranging from 20 to 96 kilograms. Indications were a gradient of 20 millimetres of mercury or more measured in all, systemic hypertension at rest in 8, and systemic hypertension at exercise in all. Of the patients, 5 were receiving anti-hypertensive treatment. Before implantation of the stents, and after a mean follow-up of 22 months, all patients underwent an exercise test, vascular echography, and examination of the common carotid artery so as to determine its cross sectional compliance and distensibility, and the augmentation index. results: The stents were implanted successfully in all patients. The mean gradient was reduced from 27 to 4 millimetres of mercury (p < 0.001). Systolic blood pressure at rest diminished from 140 to 131 millimetres of mercury (p = 0.04), while hypertension at rest regressed in 4 patients. Systolic blood pressure at exercise diminished from 245 to 222 millimetres of mercury (p = 0.018), and hypertension at exercise regressed in 1 patient. Anti-hypertensive treatment is still required for 4 patients. A correlation was found between systolic blood pressure at rest and initial peak-to-peak gradient (r = 0.8), and between initial gradient and percentage reduction of systolic blood pressure at rest at follow-up (r = -0.73). Compliance and distensibility of the common carotid artery were not significantly modified, albeit that the intimal medial thickness diminished from 0.64 to 0.57 millimetres (p = 0.04), and the augmentation index decreased from 5 to -1 (p = 0.012).
Primary implantation of stents is effective in mid-term repair of aortic recoarctation. Although there is an improvement in systemic hypertension, the tensional profile and vascular sonography are not normalized. At long term follow-up, the suppression of an early reflection site of the pulse wave could decrease the wall stress of the great elastic vessels, reducing the thickness of the arterial walls.
尽管支架植入术对压力曲线、颈动脉力学特性、内膜中层厚度及脉搏波反射的影响尚未得到系统研究，但原发性主动脉缩窄支架植入术是一种公认的治疗技术。
在1999年1月1日至2002年12月31日期间，我们为15例主动脉缩窄患者植入支架以缓解病情，患者年龄中位数为17岁，范围在7至29岁之间，体重中位数为56千克，范围在20至96千克之间。所有患者测量的压差均为20毫米汞柱或更高，8例患者静息时出现全身性高血压，所有患者运动时出现全身性高血压。其中5例患者正在接受抗高血压治疗。在植入支架前以及平均随访22个月后，所有患者均接受运动试验、血管超声检查以及颈总动脉检查，以确定其横截面积顺应性、扩张性及增强指数。结果：所有患者支架植入均成功。平均压差从27毫米汞柱降至4毫米汞柱（p<0.001）。静息时收缩压从140毫米汞柱降至131毫米汞柱（p=0.04），4例静息时高血压患者病情缓解。运动时收缩压从245毫米汞柱降至222毫米汞柱（p=0.018），1例运动时高血压患者病情缓解。4例患者仍需抗高血压治疗。发现静息时收缩压与初始峰峰值压差之间存在相关性（r=0.8），初始压差与随访时静息收缩压降低百分比之间存在相关性（r=-0.73）。颈总动脉的顺应性和扩张性未发生显著改变，尽管内膜中层厚度从0.64毫米降至0.57毫米（p=0.04），增强指数从5降至-1（p=0.012）。
原发性主动脉缩窄支架植入术在主动脉缩窄的中期修复中有效。尽管全身性高血压有所改善，但张力曲线和血管超声检查并未恢复正常。在长期随访中，脉搏波早期反射点的抑制可降低大弹性血管的壁应力，减少动脉壁厚度。
