Hijazi Z M, Fahey J T, Kleinman C S, Hellenbrand W E
Department of Pediatrics and Pediatric Cardiology, Yale University School of Medicine, New Haven, Conn. 06510.
Circulation. 1991 Sep;84(3):1150-6. doi: 10.1161/01.cir.84.3.1150.
As angioplasty techniques have been refined and larger low-profile balloons developed, a nonsurgical approach to recoarctation has become available. Several reports have documented both the efficacy and safety of this procedure. However, there are little data available on the long-term follow-up of these patients. This report details the initial results and long-term evaluation of both the relief of obstruction and the presence of hypertension after balloon angioplasty for recurrent coarctation.
Balloon angioplasty for recurrent coarctation of the aorta was performed 29 times in 26 patients at a median age of 4 years and 9 months (range, 4 months to 29 years), with eight patients less than 1 year old. Initial surgical techniques were end-to-end anastomosis in 11 patients, subclavian flap aortoplasty in 11 patients, and patch aortoplasty in four patients. Angioplasty was performed at a median interval of 2 years and 7 months (range, 4 months to 23 years) after surgery. Mean peak systolic pressure difference across the coarctation decreased from 40.0 +/- 16.8 to 10.3 +/- 9.5 mm Hg (p less than 0.05) after the initial angioplasty, and mean diameter of the aortic lumen at the coarctation site increased from 5.8 +/- 3.5 to 9.0 +/- 4.3 mm (p less than 0.05). There was no mortality, and only one patient developed an aneurysm (4%). Three patients underwent repeat angioplasty for a pressure difference of more than 20 mm Hg. Long-term follow-up is available on 24 of 26 patients with a mean follow-up of 42 +/- 24 months (range, 12-88 months). Mean peak systolic pressure difference across the area of coarctation decreased from 40.3 +/- 17.4 before angioplasty to 8.5 +/- 8.3 mm Hg after final angioplasty (p less than 0.05) and 7.5 +/- 7.5 mm Hg at follow-up. Mean peak systolic blood pressure in the upper extremities decreased from 133.1 +/- 14.9 before angioplasty to 111.1 +/- 14.1 mm Hg at long-term follow-up (p less than 0.05).
Balloon angioplasty should be considered the treatment of choice for relief of recurrent aortic coarctation.
随着血管成形术技术的不断完善以及更大尺寸的低轮廓球囊的研发，一种针对再缩窄的非手术方法已成为可能。多项报告记录了该手术的有效性和安全性。然而，关于这些患者的长期随访数据却很少。本报告详细阐述了球囊血管成形术治疗复发性主动脉缩窄后梗阻解除及高血压情况的初始结果和长期评估。
对26例患者进行了29次球囊血管成形术治疗复发性主动脉缩窄，患者中位年龄为4岁9个月（范围4个月至29岁），其中8例患者年龄小于1岁。初始手术方式为11例患者行端端吻合术，11例患者行锁骨下动脉瓣主动脉成形术，4例患者行补片主动脉成形术。血管成形术在手术后的中位间隔时间为2年7个月（范围4个月至23年）进行。首次血管成形术后，缩窄部位的平均收缩压峰值压差从40.0±16.8降至10.3±9.5 mmHg（p<0.05），缩窄部位主动脉腔的平均直径从5.8±3.5增加至9.0±4.3 mm（p<0.05）。无死亡病例，仅1例患者发生动脉瘤（4%）。3例患者因压差超过20 mmHg接受了重复血管成形术。26例患者中有24例获得长期随访，平均随访时间为42±24个月（范围12 - 88个月）。缩窄部位的平均收缩压峰值压差从血管成形术前的40.3±17.4降至最后一次血管成形术后的8.5±8.3 mmHg（p<0.05），随访时为7.5±7.5 mmHg。上肢平均收缩压峰值从血管成形术前的133.1±14.9降至长期随访时的111.1±14.1 mmHg（p<0.05）。
球囊血管成形术应被视为缓解复发性主动脉缩窄的首选治疗方法。
