Zeltser Ilana, Menteer Jondavid, Gaynor J William, Spray Thomas L, Clark Bernard J, Kreutzer Jacqueline, Rome Jonathan J
Division of Cardiology, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
J Am Coll Cardiol. 2005 Jun 7;45(11):1844-8. doi: 10.1016/j.jacc.2005.01.056.
The objective of this study was to determine the efficacy of balloon angioplasty (BA) by comparing the immediate and long-term outcomes of patients with and without re-coarctation after a Norwood procedure.
Although BA has become the standard means for treating recurrent coarctation following a Norwood operation, it has been suggested that re-coarctation remains a significant cause of morbidity and mortality.
Patients who survived a Norwood operation from December 1986 through June 2001 were studied. Differences between groups were evaluated by t test and logistic regression. Survival differences were tested by log-rank tests using Kaplan-Meier survival curves.
Fifty-eight of 633 patients underwent treatment for re-coarctation (9.2%). Thirty-five patients underwent BA (before 1988, 23 had surgery). Median age at catheterization was 6.6 months (1.9 to 35.6 months). Balloon angioplasty was successful (gradient <10 mm Hg) in 32 of 35 patients (92%). There were no BA-related deaths or neurologic complications. Recurrent obstruction after BA occurred in seven patients (20%); five underwent re-dilation. Kaplan-Meier estimates of freedom from recurrent obstruction after initial BA were 97% at one month, 79% at one year, and 79% at five years. There were no differences in survival between patients with re-coarctation treated by BA and patients who did not undergo treatment for re-coarctation.
We found that 9.2% of patients underwent treatment for re-coarctation following a Norwood operation. Balloon angioplasty is effective, with low morbidity, no early mortality, and no difference in long-term survival when compared with patients who did not have re-coarctation. Recurrent coarctation following BA occurred in 17% of patients, usually within the first year after BA.
本研究的目的是通过比较诺伍德手术后有或没有再缩窄的患者的近期和长期结果，来确定球囊血管成形术（BA）的疗效。
尽管BA已成为治疗诺伍德手术后复发性缩窄的标准方法，但有人提出再缩窄仍然是发病和死亡的重要原因。
对1986年12月至2001年6月期间接受诺伍德手术存活的患者进行研究。通过t检验和逻辑回归评估组间差异。使用Kaplan-Meier生存曲线通过对数秩检验来检验生存差异。
633例患者中有58例接受了再缩窄治疗（9.2%）。35例患者接受了BA（1988年前，23例接受了手术）。导管插入术时的中位年龄为6.6个月（1.9至35.6个月）。35例患者中有32例（92%）球囊血管成形术成功（压差<10 mmHg）。没有与BA相关的死亡或神经系统并发症。BA后7例患者（20%）出现复发性梗阻；5例接受了再次扩张。初次BA后无复发性梗阻的Kaplan-Meier估计值在1个月时为97%，1年时为79%，5年时为79%。接受BA治疗的再缩窄患者与未接受再缩窄治疗的患者在生存方面没有差异。
我们发现9.2%的患者在诺伍德手术后接受了再缩窄治疗。球囊血管成形术是有效的，发病率低，无早期死亡率，与没有再缩窄的患者相比，长期生存率没有差异。BA后17%的患者出现复发性缩窄，通常在BA后的第一年内。
