Rao P S, Chopra P S
Department of Pediatrics, University of Wisconsin Medical School, Madison.
Ann Thorac Surg. 1991 Sep;52(3):621-31. doi: 10.1016/0003-4975(91)90961-o.
Since the initial report of coarctation balloon angioplasty in 1982, several groups have used this technique for native coarctations in neonates, infants, and children and for postoperative recoarctations. However, recommendations for use of balloon angioplasty as a treatment procedure of choice are clouded by reports of aneurysm development at the site of coarctation. Here we review our experience as well as that published in the literature, including Valvuloplasty and Angioplasty of Congenital Anomalies Registry data, and present evidence in support of balloon angioplasty as a therapeutic procedure of choice for treating native and recurrent postoperative aortic coarctations. Balloon angioplasty of native aortic coarctations in 20 neonates and infants 1 year old or less reduced peak systolic pressure gradient across the coarctation from 40 +/- 12 mm Hg (mean +/- standard deviation) to 11 +/- 8 mm Hg (p less than 0.001); no patient required immediate surgical intervention. The residual gradient at follow-up (mean follow-up, 12 months) in 16 infants was 18 +/- 16 mm Hg, a significant improvement (p less than 0.01) compared with preangioplasty values. In none of the patients did an aneurysm develop. Recoarctation developed in 5 (31%) of the 16 infants and was successfully treated either by surgical resection (in 2) or by repeat balloon angioplasty (in 3). A comparison of mortality and recurrence rates between the balloon angioplasty and surgical groups was made with the help of data pooled from the literature published since 1980. The initial (7% versus 23%) and late (2% versus 25%) mortality and recoarctation (11% versus 18%) rates were higher (p less than 0.025) after surgical intervention than after balloon therapy. When only reports in which patients were operated on after 1979 were included in this type of analysis, the initial and late mortality rates remained higher (p less than 0.01) after operation than after angioplasty, and the recoarctation rates became similar (p greater than 0.1). Thirty-two children (greater than 1 year old) underwent balloon angioplasty of native coarctation with a resultant reduction in peak systolic pressure gradient from 48 +/- 19 mm Hg to 10 +/- 9 mm Hg (p less than 0.001), which continued to remain low (14 +/- 11 mm Hg; p less than 0.001) at follow-up catheterization in 24 children 13 months (mean) later. There were no immediate or late deaths. A small aneurysm developed in 1 patient (4%) but did not require intervention. Recoarctation developed in 2 patients (8%), and in both, repeat balloon angioplasty was performed with good results.(ABSTRACT TRUNCATED AT 400 WORDS)
自1982年首次报道主动脉缩窄球囊血管成形术以来，多个研究小组已将该技术用于新生儿、婴儿和儿童的原发性主动脉缩窄以及术后再狭窄。然而，关于将球囊血管成形术作为首选治疗方法的建议因缩窄部位动脉瘤形成的报道而变得模糊不清。在此，我们回顾了我们的经验以及文献中发表的经验，包括先天性异常瓣膜成形术和血管成形术登记数据，并提供证据支持球囊血管成形术作为治疗原发性和复发性术后主动脉缩窄的首选治疗方法。对20例1岁及以下的新生儿和婴儿进行原发性主动脉缩窄球囊血管成形术，使缩窄部位的收缩压峰值梯度从40±12 mmHg（平均值±标准差）降至11±8 mmHg（p<0.001）；无患者需要立即进行手术干预。16例婴儿随访时（平均随访12个月）的残余梯度为18±16 mmHg，与血管成形术前的值相比有显著改善（p<0.01）。所有患者均未发生动脉瘤。16例婴儿中有5例（31%）出现再狭窄，其中2例通过手术切除成功治疗，3例通过重复球囊血管成形术成功治疗。借助自1980年以来发表的文献汇总数据，对球囊血管成形术组和手术组的死亡率和复发率进行了比较。手术干预后的初始死亡率（7%对23%）和晚期死亡率（2%对25%）以及再狭窄率（11%对18%）均高于球囊治疗后（p<0.025）。当此类分析仅纳入1979年后接受手术的患者报告时，术后的初始和晚期死亡率仍高于血管成形术后（p<0.01），而再狭窄率变得相似（p>0.1）。32例（大于1岁）儿童接受原发性缩窄球囊血管成形术，收缩压峰值梯度从48±19 mmHg降至10±9 mmHg（p<0.001），13个月（平均）后对24例儿童进行随访导管检查时该值仍保持在较低水平（14±11 mmHg；p<0.001）。无即刻或晚期死亡。1例患者（4%）出现小动脉瘤，但无需干预。2例患者（8%）出现再狭窄，二者均通过重复球囊血管成形术治疗，效果良好。（摘要截断于400字）
