Kaemmerer H, Ehrenheim C, Wilken W, Burchert W, Luhmer I, Hundeshagen H, Kallfelz H C
Kinderklinik, Abt. für Pädiatrische Kardiologie, Medizinischen Hochschule Hannover.
Z Kardiol. 1990 Nov;79(11):766-73.
Aortic aneurysm and stenosis are the most severe post-interventional complications after angioplasty of CoA and require regular follow-up. Twenty children (4 2/12-13 11/12 years old) underwent MRI within 3 months to 5 7/12 years after dilatation. All children were in a good state of health and showed no signs of heart failure. Three patients suffered from arterial hypertension; seven children showed hypertension on exertion. In six children, a resting gradient (minimal 20 mm Hg, maximal 40 mm Hg) between the upper and lower extremities could be measured. Four children showed pathological changes of the ascending aorta, three had a moderate ectasia, one had severe dilatation of more than 5 cm in diameter. In three cases, a circumscript aneurysm of the descending aorta was found. In many cases, there were mild changes in the aortic wall in the region of dilatation. In 12 children, there was a moderate spindly dilatation distal to the aortic isthmus, which, however, could be seen in the pre-dilatation angiography. After dilatation of CoA, several patients continue to have hypertension and pathological changes of the thoracic aorta. With regard to adequate therapy, regular controls are necessary. Besides routine examinations, MRI is an effective non invasive imaging method for the initial investigation and short-time follow-up evaluation of CoA.
主动脉瘤和狭窄是主动脉缩窄血管成形术后最严重的介入后并发症，需要定期随访。20名儿童（4又2/12至13又11/12岁）在扩张后3个月至5又7/12年接受了磁共振成像（MRI）检查。所有儿童健康状况良好，无心力衰竭迹象。3例患者患有动脉高血压；7名儿童运动时出现高血压。6名儿童可测量到上下肢之间的静息压差（最小20毫米汞柱，最大40毫米汞柱）。4名儿童升主动脉出现病理改变，3例有中度扩张，1例直径扩张超过5厘米，为重度扩张。3例发现降主动脉局限性动脉瘤。许多病例中，扩张区域的主动脉壁有轻度改变。12名儿童在主动脉峡部远端有中度梭形扩张，不过在扩张前血管造影中也可见到。主动脉缩窄扩张后，部分患者仍有高血压和胸主动脉病理改变。关于适当治疗，定期检查很有必要。除常规检查外，MRI是主动脉缩窄初始检查和短期随访评估的有效无创成像方法。
