Rao P S, Wilson A D, Chopra P S
Department of Pediatrics, University of Wisconsin Medical School, Madison.
Am Heart J. 1990 Dec;120(6 Pt 1):1315-20. doi: 10.1016/0002-8703(90)90242-p.
The purpose of this article is to present immediate and follow-up results of balloon angioplasty of aortic recoarctations following previous surgery in infants and children. During a 45-month period that ended in June 1989, nine infants and children, ages 6 months to 7 years, underwent balloon angioplasty of recoarctation with resultant reduction in peak-to-peak systolic pressure gradient from 52 +/- 20 mm Hg (mean +/- SD) to 16 +/- 8 mm Hg (p less than 0.001) and increase in coarctation segment size from 3.4 +/- 1.4 mm to 6.1 +/- 1.6 mm (p less than 0.01). None required surgical intervention. There were no significant complications. Follow-up catheterization (16 +/- 7 months) data in six children and follow-up clinical (17 +/- 6 months) data in all children were available for review. Both the residual coarctation pressure gradient (6 +/- 6 mm Hg) and coarctation segment size (8.2 +/- 2.4 mm) remain improved (p less than 0.001) when compared with pre-balloon angioplasty values and the pressure gradient fell further (p less than 0.01) when compared with that measured immediately after balloon angioplasty. None developed restenosis, although one child required surgical relief of severe narrowing of isthmus of the aortic arch. None developed aneurysms. On the basis of this experience and that reported in the literature and because of high morbidity and mortality rates associated with repeat surgery for postoperative recoarctation, we recommend balloon angioplasty as the procedure of choice for relief of postoperative recoarctation with significant hypertension.
本文旨在介绍婴儿和儿童先前手术后主动脉缩窄球囊血管成形术的即时和随访结果。在截至1989年6月的45个月期间，9名年龄在6个月至7岁的婴儿和儿童接受了缩窄球囊血管成形术，收缩期峰值压力梯度从52±20 mmHg（均值±标准差）降至16±8 mmHg（p<0.001），缩窄段尺寸从3.4±1.4 mm增加到6.1±1.6 mm（p<0.01）。无一例需要手术干预。无显著并发症。6名儿童有随访导管检查数据（16±7个月），所有儿童有随访临床数据（17±6个月）可供审查。与球囊血管成形术前的值相比，残余缩窄压力梯度（6±6 mmHg）和缩窄段尺寸（8.2±2.4 mm）仍有所改善（p<0.001），与球囊血管成形术后立即测量的值相比，压力梯度进一步下降（p<0.01）。尽管有一名儿童需要手术缓解主动脉弓峡部的严重狭窄，但无一例发生再狭窄。无一例发生动脉瘤。基于本经验及文献报道，且因术后缩窄再次手术相关的高发病率和死亡率，我们推荐球囊血管成形术作为缓解伴有显著高血压的术后缩窄的首选方法。
