Webb Gary
Children's Hospital of Philadelphia, Philadelphia, PA 19104-4283, USA.
Semin Thorac Cardiovasc Surg. 2005 Summer;17(2):139-42. doi: 10.1053/j.semtcvs.2005.03.001.
This article discusses coarctation of the aorta in the adult. Effective treatments for coarctation have come from surgery since 1945 and from interventional cardiology since 1982. Long-term outcome data are available only for surgical approaches. Thirty-year survival rate is 72% to 82%. Complications include recoarctation or residual coarctation, hypertension, aneurysms at the repair site, spinal cord injury. Other sequelae include bicuspid aortic valve disease, ascending aortic aneurysm, premature coronary disease, and infective endocarditis or endarteritis. Interventional catheter therapy is now the preferred therapy for recurrent coarctation, when the anatomy permits and necessary skills are available. Its use in native or unoperated coarctation is less well established. Treatment may be with balloon angioplasty alone or with a stent. Outcomes are good in skilled hands, but residual or recurrent coarctation with resultant hypertension and repair site aneurysms can occur. Catheter treatment can cause death from aortic rupture and dissection, but mortality compares favorably with surgery if coarctation is recurrent, and perhaps for initial treatment.
本文讨论成人主动脉缩窄。自1945年起，手术成为主动脉缩窄的有效治疗方法；自1982年起，介入心脏病学也用于治疗该病。目前仅有手术治疗方法的长期预后数据。30年生存率为72%至82%。并发症包括再缩窄或残余缩窄、高血压、修复部位动脉瘤、脊髓损伤。其他后遗症包括二叶式主动脉瓣疾病、升主动脉瘤、早发性冠状动脉疾病以及感染性心内膜炎或动脉内膜炎。当解剖结构允许且具备必要技能时，介入导管治疗是复发性主动脉缩窄的首选治疗方法。其在原发性或未经手术治疗的主动脉缩窄中的应用尚未得到充分证实。治疗可单独采用球囊血管成形术或置入支架。在技术熟练的情况下，治疗效果良好，但仍可能出现残余或复发性缩窄，并导致高血压和修复部位动脉瘤。导管治疗可导致主动脉破裂和夹层分离致死，但如果是复发性主动脉缩窄，或许对于初始治疗而言，导管治疗的死亡率与手术相比更具优势。
