Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke's Episcopal Hospital/Baylor College of Medicine, Houston, Texas, USA.
Ann Thorac Surg. 2013 Jun;95(6):1961-7; discussion 1967. doi: 10.1016/j.athoracsur.2013.03.062. Epub 2013 May 2.
We evaluated the occurrence and treatment of aortic aneurysms in coarctation patients.
During 1962 to 2011, 943 cases of coarctation were repaired. Aortic aneurysms were identified in 55 patients (5.8%). Forty-eight had prior coarctation repair (median 23 years earlier, interquartile range 18 to 26 years). Forty-two aneurysms were found in the descending thoracic aorta (76.4%), 18 in the ascending aorta (32.7%), 8 in the left subclavian artery (14.5%), and 1 each (1.8%) in the abdominal aorta, iliac artery, and innominate artery. Twenty-three patients (41.8%) had multiple aneurysms. Twenty-five patients (45.4%) had a bicuspid aortic valve.
Fifty-three patients' aneurysms were treated surgically. Thirty-five (66.0%) had descending thoracic aortic repair, of whom 11 had aorto-left subclavian bypass. Aortic cross-clamping alone was used in 23 patients, left heart bypass in 4, and circulatory arrest in 8. Eleven patients underwent endovascular repair (20.8%). Proximal aortic aneurysms were repaired in 7 patients (13.2%); 1 had simultaneous antegrade endostent delivery. Four patients had ascending-to-descending aortic bypass (7.3%). Concomitant valve-sparing root repair was performed in 2 patients, Bentall in 4, aortic valve replacement in 3, and coronary artery bypass in 1. One 30-day death occurred (1.9%). Three patients (5.7%) had transient neurologic deficits, 2 (3.8%) required tracheostomy, and 11 (20.8%) had vocal cord paralysis.
Coarctation is a marker for aortic aneurysm formation in adults and merits long-term surveillance. Anatomic complexity and associated conditions can complicate the surgical repair. Various open, extra-anatomic, and endovascular techniques may be used.
我们评估了缩窄患者中主动脉瘤的发生和治疗情况。
在 1962 年至 2011 年间，共修复了 943 例缩窄病例。在 55 例患者（5.8%）中发现了主动脉瘤。其中 48 例患者有既往的缩窄修复史（中位数为 23 年前，四分位间距为 18 至 26 年）。42 例动脉瘤位于降主动脉（76.4%），18 例位于升主动脉（32.7%），8 例位于左锁骨下动脉（14.5%），1 例（1.8%）位于腹主动脉、髂动脉和无名动脉。23 例患者（41.8%）有多发性动脉瘤。25 例患者（45.4%）有二叶式主动脉瓣。
53 例患者的动脉瘤接受了手术治疗。其中 35 例（66.0%）行降主动脉修复术，其中 11 例行主动脉至左锁骨下动脉旁路术。23 例患者仅采用主动脉夹闭，4 例采用左心旁路，8 例采用体外循环。11 例患者接受了血管内修复（20.8%）。7 例患者（13.2%）修复了近端主动脉瘤，其中 1 例同时行顺行支架输送。4 例患者行升主动脉至降主动脉旁路术（7.3%）。同时行保留瓣膜的根部修复术 2 例，Bentall 手术 4 例，主动脉瓣置换术 3 例，冠状动脉旁路移植术 1 例。1 例患者在术后 30 天死亡（1.9%）。3 例患者（5.7%）出现短暂性神经功能缺损，2 例（3.8%）需要气管切开术，11 例（20.8%）发生声带麻痹。
缩窄是成人主动脉瘤形成的标志，需要长期监测。解剖复杂性和相关情况可能使手术修复复杂化。各种开放、解剖外和血管内技术均可使用。
