Russell G A, Berry P J, Watterson K, Dhasmana J P, Wisheart J D
Department of Pathology, Bristol Royal Hospital for Sick Children, United Kingdom.
J Thorac Cardiovasc Surg. 1991 Oct;102(4):596-601.
A possible relationship between recurrence of coarctation and the presence of residual ductal tissue in the aorta was studied by defining the presence and pattern of ductal tissue in aortic segments from 23 patients less than 3 months of age who underwent resection of coarctation of the aorta. The surgical policy was to perform extensive excision of the coarctation, including a wide margin of descending aorta beyond the ductus arteriosus. Histologic examination showed that there was a circumferential sling of ductal tissue extending from the ductus arteriosus and surrounding the aorta at the level of the coarctation shelf in 22 specimens. In 15 of these specimens one or two tonguelike prolongations of ductal tissue extended distally from the circumferential sling and occupied constant positions in the aortic wall; one tonguelike prolongation extended distally below the insertion of the ductus and the other from the circumferential sling opposite the ductal insertion. Incomplete excision of ductal tissue was found in 11 specimens. In relation to the goal of avoiding recurrent coarctation after repair in the early months of life, the possible implications of these findings are discussed, and, in particular, a possible mechanism of recurrence after subclavian flap aortoplasty is proposed.
通过确定23例年龄小于3个月的主动脉缩窄切除术患者主动脉段中导管组织的存在情况和模式，研究了主动脉缩窄复发与主动脉中残留导管组织之间的可能关系。手术策略是对缩窄段进行广泛切除，包括动脉导管远端降主动脉的宽边。组织学检查显示，22个标本中存在从动脉导管延伸并在缩窄嵴水平围绕主动脉的导管组织环形吊带。在其中15个标本中，一或两个导管组织舌状延长部分从环形吊带向远端延伸，并在主动脉壁中占据固定位置；一个舌状延长部分在动脉导管插入点下方远端延伸，另一个从与动脉导管插入点相对的环形吊带处延伸。在11个标本中发现导管组织切除不完全。针对在生命早期修复后避免复发性主动脉缩窄这一目标，讨论了这些发现的可能影响，特别是提出了锁骨下皮瓣主动脉成形术后复发的可能机制。
