Tokel Kursad, Yildirim Selman Vefa, Varan Birgul, Ekici Enver
Department of Pediatric Cardiology, Baskent University, Ankara, Turkey.
J Invasive Cardiol. 2006 Feb;18(2):65-9.
Combined aortic valvular stenosis (AVS) and coarctation of the aorta (CoA) is uncommon. There are only a few case reports that discuss the treatment choices and prognosis. We present the immediate and long-term results for a group of children with combined AVS and CoA who underwent sequential percutaneous balloon dilatation in a single catheterization procedure.
The cases of 13 children with combined AVS and CoA who underwent balloon dilatation in a single catheterization session between August 1995 and May 2002 were retrospectively evaluated. The group was comprised of 9 boys and 4 girls of mean age 14.9 +/- 24.2 months (range = 19 days to 7 years).
The pressure gradients at the valvular level before and after the intervention were 51.5 +/- 22.3 mmHg (range = 8 to 85 mmHg) and 22.4 +/- 18.3 mmHg (range = 2 to 57 mmHg), respectively (p < 0.001). The corresponding findings for the coarctation segment were 22.3 +/- 13.5 mmHg (range = 0 to 45 mmHg), and 5.2 +/- 7.0 mmHg (range = 0 to 24 mmHg; p < 0.001). After the intervention, mild aortic regurgitation occurred in 5 children (38.5%). Mild aortic regurgitation became moderate in 1 patient (7.7%). Three patients developed peripheral arterial occlusion treated with heparin and streptokinase after intervention. There were no deaths during or early after the procedures. Four patients (30.8%) died, all in the first 6 months after the intervention, and the mean follow-up time for the 9 survivors was 57.6 +/- 38.9 months (range = 6 to 107 months). Recurrence of stenosis and coarctation occurred in 2 (15.4%) and 4 (30.8%) cases, respectively. Four patients (30.8%) underwent cardiac surgery. The event-free survival rates were 76.9% at 6 months, 61.5% at 12 months through 24 months, and 30.8% at 60 months. The overall survival rates were 76.9% at 3 months, 69.2% at 6 months, and it remained 69.2% for the rest of the follow-up period. NOTE: Outcomes for 13 patients with combined AVS and CoA who underwent single-session sequential balloon dilatation are described. The results were favorable; there were no severe complications related to the procedures, and no deaths occurred during or in the early period after the intervention.
主动脉瓣狭窄（AVS）合并主动脉缩窄（CoA）并不常见。仅有少数病例报告讨论了治疗选择和预后情况。我们呈现了一组患有AVS合并CoA的儿童在单次心导管插入术中接受序贯经皮球囊扩张术的近期和长期结果。
回顾性评估了1995年8月至2002年5月期间在单次心导管插入术中接受球囊扩张术的13例AVS合并CoA患儿的病例。该组包括9名男孩和4名女孩，平均年龄为14.9±24.2个月（范围为19天至7岁）。
干预前后瓣膜水平的压力阶差分别为51.5±22.3 mmHg（范围为8至85 mmHg）和22.4±18.3 mmHg（范围为2至57 mmHg）（p<0.001）。主动脉缩窄段的相应结果分别为22.3±13.5 mmHg（范围为0至45 mmHg）和5.2±7.0 mmHg（范围为0至24 mmHg；p<0.001）。干预后，5名患儿（38.5%）出现轻度主动脉瓣反流。1名患者（7.7%）的轻度主动脉瓣反流变为中度。3名患者在干预后发生外周动脉闭塞，经肝素和链激酶治疗。术中及术后早期无死亡病例。4名患者（30.8%）死亡，均在干预后的前6个月内，9名存活者的平均随访时间为57.6±38.9个月（范围为6至107个月）。狭窄和缩窄复发分别发生在2例（15.4%）和4例（30.8%）。4名患者（30.8%）接受了心脏手术。6个月时无事件生存率为76.9%，12个月至24个月时为61.5%，60个月时为30.8%。3个月时总生存率为76.9%，6个月时为69.2%，在其余随访期内维持在69.2%。注意：描述了13例AVS合并CoA患者在单次序贯球囊扩张术中的结果。结果良好；未出现与手术相关的严重并发症，干预期间及干预后早期无死亡病例。
