Malan J E, Benatar A, Levin S E
Department of Paediatrics, Johannesburg Hospital, South Africa.
Int J Cardiol. 1991 Jan;30(1):23-32. doi: 10.1016/0167-5273(91)90120-e.
The long-term complications of patch plasty repair for coarctation of the aorta were assessed retrospectively in 119 patients who were operated upon from 4 days to 13 years of age. There were 7 late deaths and 17 patients were lost to follow-up. Thus 95 patients were followed up for a minimum period of 3 years (mean 6.3 years). In addition, graded exercise tests were performed on 15 patients and 11 normal controls, measuring systolic blood pressure response and arm-leg blood pressure gradients. In this series, 16 patients (17%) were hypertensive, while 25 (26%) had a resting systolic arm-leg gradient greater than 20 mm Hg. Re-coarctation occurred more frequently when surgery had been undertaken under 1 month of age. Review of chest X-rays revealed calcification in the patch in 4 patients, one of whom subsequently went on to aneurysm formation. In a second child aneurysm formation was detected at repeat operation. Exercise tests showed a significantly higher systolic arm pressure in patients (mean: 165.3 mm Hg) when compared to controls (mean: 139.2 mm Hg) (P = 0.017) and a significant increase in arm-leg systolic gradient viz. 36 and 5.9 mm Hg, respectively (P = 0.0016). A good correlation was found between the systolic arm pressure and the systolic arm-leg gradient after exercise (r = 0.822; P = 0.0001). We conclude that the most important long-term complication following an aortic patch plasty, is re-stenosis. The development of an aneurysm was observed only twice. We believe that this apparently rare occurrence, as assessed on chest radiographs; is related to the young age (53% under 1 year) at which the repairs were carried out. Another possible reason may be that the follow-up period is not yet long enough.
对119例年龄在4天至13岁之间接受手术治疗的主动脉缩窄补片成形术患者的长期并发症进行了回顾性评估。有7例晚期死亡，17例患者失访。因此，95例患者接受了至少3年的随访（平均6.3年）。此外，对15例患者和11名正常对照者进行了分级运动试验，测量收缩压反应和臂-腿血压梯度。在该系列中，16例患者（17%）患有高血压，而25例（26%）静息时臂-腿收缩压梯度大于20 mmHg。手术在1个月龄以下进行时，再缩窄更频繁发生。胸部X线复查显示4例患者补片有钙化，其中1例随后发展为动脉瘤形成。在另一名儿童中，再次手术时发现动脉瘤形成。运动试验显示，与对照组（平均：139.2 mmHg）相比，患者的收缩臂压显著更高（平均：165.3 mmHg）（P = 0.017），臂-腿收缩压梯度显著增加，分别为36 mmHg和5.9 mmHg（P = 0.0016）。运动后收缩臂压与收缩臂-腿梯度之间发现良好的相关性（r = 0.822；P = 0.0001）。我们得出结论，主动脉补片成形术后最重要的长期并发症是再狭窄。仅观察到2例动脉瘤形成。我们认为，如胸部X线片评估所示，这种明显罕见的情况与手术时的年轻年龄（53%在1岁以下）有关。另一个可能的原因可能是随访期还不够长。
