Hoffman James L, Gray Robert G, LuAnn Minich L, Wilkinson Stephen E, Heywood Mason, Edwards Reggie, Weng Hsin Ti, Su Jason T
Division of Pediatric Cardiology, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
Pediatr Cardiol. 2014 Jan;35(1):47-52. doi: 10.1007/s00246-013-0737-x. Epub 2013 Jun 23.
Isolated coarctation of the aorta (CoA) occurs in 6-8 % of patients with congenital heart disease. After successful relief of obstruction, patients remain at risk for aortic aneurysm formation at the site of the repair. We sought to determine the diagnostic utility of echocardiography compared with advanced arch imaging (AAI) in diagnosing aortic aneurysms in pediatric patients after CoA repair. The Congenital Heart Databases from 1996 and 2009 were reviewed. All patients treated for CoA who had AAI defined by cardiac magnetic resonance imaging (MRI), computed tomography (CT), or catheterization were identified. Data collected included the following: type, timing, and number of interventions, presence and time to aneurysm diagnosis, and mortality. Patients were subdivided into surgical and catheterization groups for analysis. Seven hundred and fifty-nine patients underwent treatment for CoA during the study period. Three hundred and ninety-nine patients had at least one AAI. Aneurysms were diagnosed by AAI in 28 of 399 patients at a mean of 10 ± 8.4 years after treatment. Echocardiography reports were available for 380 of 399 patients with AAI. The sensitivity of echocardiography for detecting aneurysms was 24 %. The prevalence of aneurysms was significantly greater in the catheterization group (p < 0.05) compared with the surgery group. Aneurysm was also diagnosed earlier in the catheterization group compared with the surgery group (p = 0.02). Multivariate analysis showed a significantly increased risk of aneurysm diagnosis in patients in the catheterization subgroup and in patients requiring more than three procedures. Aortic aneurysms continue to be an important complication after CoA repair. Although serial echocardiograms are the test of choice for following-up most congenital cardiac lesions in pediatrics, our data show that echocardiography is inadequate for the detection of aneurysms after CoA repair. Because the time to aneurysm diagnosis was shorter and the risk greater in the catheterization group (particularly for patients requiring more than one procedure), surveillance with cardiac MRI or CT should begin earlier in these patients.
孤立性主动脉缩窄（CoA）在6% - 8%的先天性心脏病患者中出现。梗阻成功解除后，患者仍有在修复部位形成主动脉瘤的风险。我们试图确定与高级主动脉弓成像（AAI）相比，超声心动图在诊断CoA修复术后儿科患者主动脉瘤方面的诊断效用。回顾了1996年和2009年的先天性心脏病数据库。确定了所有接受过CoA治疗且通过心脏磁共振成像（MRI）、计算机断层扫描（CT）或心导管检查定义为有AAI的患者。收集的数据包括以下内容：干预的类型、时间和次数、动脉瘤诊断的存在情况和时间以及死亡率。患者被分为手术组和导管介入组进行分析。在研究期间，759例患者接受了CoA治疗。399例患者至少进行了一次AAI。399例患者中有28例通过AAI诊断出动脉瘤，平均在治疗后10±8.4年。399例有AAI的患者中有380例有超声心动图报告。超声心动图检测动脉瘤的敏感性为24%。与手术组相比，导管介入组的动脉瘤患病率显著更高（p<0.05）。与手术组相比，导管介入组也更早诊断出动脉瘤（p = 0.02）。多变量分析显示，导管介入亚组患者和需要进行三次以上手术的患者动脉瘤诊断风险显著增加。主动脉瘤仍然是CoA修复术后的一个重要并发症。虽然系列超声心动图是儿科大多数先天性心脏病变随访的首选检查，但我们的数据表明，超声心动图不足以检测CoA修复术后的动脉瘤。由于导管介入组动脉瘤诊断时间更短且风险更高（特别是对于需要进行一次以上手术的患者），这些患者应更早开始使用心脏MRI或CT进行监测。
