Fawzy Mohamed Eid, Fathala Ahmed, Osman Adil, Badr Amr, Mostafa Mohammed Adel, Mohamed Gamal, Dunn Bruce
King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Am Heart J. 2008 Nov;156(5):910-7. doi: 10.1016/j.ahj.2008.06.037. Epub 2008 Sep 24.
Although the immediate and intermediate-term results of balloon angioplasty (BA) for patients with aortic coarctation (AC) have been encouraging, there is paucity of data on long-term follow-up results. This study evaluated the long-term (up to 22 years) follow-up results of BA in adolescent and adult patients with discrete (shelf-like) coarctation of the aorta.
Follow-up data of 58 patients (mean age 24+/-9 years) undergoing BA for discrete AC at median interval of 13.4 years including cardiac catheterization, magnetic resonance imaging, and Doppler echocardiography form the basis of this study.
No early deaths occurred. Balloon angioplasty produced immediate reduction in peak AC gradient from 60+/-22 mm Hg to 8.5+/-8 mm Hg (P<.0001). Follow-up catheterization 12 months later revealed a residual gradient of 5+/-6.4 mm Hg (P=.01). Five patients (8%) with suboptimal initial outcome (peak gradient>20 mm Hg) developed restenosis, and 4 of these had successful repeat angioplasty. Aneurysm developed at the site of dilatation in 4 patients (7%). Magnetic resonance imaging follow-up results revealed no new aneurysm. In one patient, the aneurysm increased in size, but no recoarctation or appreciable changes in the Doppler gradient across the AC site was noted. The blood pressure had normalized without medical treatment in 29 (50%) of the 58 patients.
Long-term results of BA for discrete AC are excellent and should be considered as first option for treatment of this disease.
尽管球囊血管成形术（BA）治疗主动脉缩窄（AC）患者的近期和中期结果令人鼓舞，但长期随访结果的数据却很匮乏。本研究评估了球囊血管成形术治疗青少年和成年患者局限性（架状）主动脉缩窄的长期（长达22年）随访结果。
58例（平均年龄24±9岁）因局限性主动脉缩窄接受球囊血管成形术患者的随访数据构成了本研究的基础，随访间隔中位数为13.4年，包括心脏导管检查、磁共振成像和多普勒超声心动图。
无早期死亡病例。球囊血管成形术使主动脉缩窄处峰值压差立即从60±22 mmHg降至8.5±8 mmHg（P<0.0001）。12个月后的随访导管检查显示残余压差为5±6.4 mmHg（P=0.01）。5例（8%）初始结果欠佳（峰值压差>20 mmHg）的患者发生再狭窄，其中4例成功进行了重复血管成形术。4例（7%）患者在扩张部位出现动脉瘤。磁共振成像随访结果显示无新的动脉瘤形成。1例患者的动脉瘤增大，但未发现再缩窄，且主动脉缩窄部位的多普勒压差无明显变化。58例患者中有29例（50%）未经药物治疗血压已恢复正常。
球囊血管成形术治疗局限性主动脉缩窄的长期效果极佳，应被视为该疾病治疗的首选方法。
