Harris Kevin C, Du Wei, Cowley Collin G, Forbes Thomas J, Kim Dennis W
Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada.
Catheter Cardiovasc Interv. 2014 Jun 1;83(7):1116-23. doi: 10.1002/ccd.25284. Epub 2013 Dec 4.
Balloon angioplasty (BA) is an important treatment option for coarctation of the aorta. The congenital cardiovascular interventional study consortium (CCISC) represents a multi-institutional and multi-national effort to prospectively investigate congenital cardiac interventions. A prospective observational analysis of the efficacy and safety of balloon aortic angioplasty was conducted.
Data were collected prospectively from 36 CCISC sites from 2004 to 2012. One hundred and thirty patients underwent BA for native (n = 76) and recurrent (n = 54) coarctation. Acute, short-term, and intermediate outcomes are described for BA performed in the setting of native and recurrent coarctation of the aorta. Outcome measures included residual upper to lower extremity blood pressure gradient (ULG), use of antihypertensive medications, aortic wall injury, reobstruction, and need for reintervention.
There was no procedural mortality. Acutely in native and recurrent coarctation, BA achieved an ULG less than 15 mm Hg in 73-80% and to less than 10 mm Hg in 54-68% of patients, respectively. At intermediate follow-up, ULG further improved, particularly for those who underwent initial reintervention for recurrent coarctation. No significant differences in aortic wall complications were seen and intervention free survival was similar for both groups. Following angioplasty, there was no significant difference in aortic wall complications; however follow up integrated imaging decreased over time.
BA is a safe and effective treatment for coarctation of the aorta acutely and at intermediate term. Although aortic injury occurred in patients with both native and recurrent coarctation, at intermediate follow-up, aneurysm was noted more often in those with initial intervention for native coarctation.
球囊血管成形术（BA）是主动脉缩窄的一种重要治疗选择。先天性心血管介入研究联盟（CCISC）代表了一项多机构、多国的前瞻性研究先天性心脏介入治疗的努力。对球囊主动脉血管成形术的疗效和安全性进行了前瞻性观察分析。
前瞻性收集2004年至2012年来自36个CCISC站点的数据。130例患者接受了BA治疗，其中原发性（n = 76）和复发性（n = 54）主动脉缩窄。描述了在原发性和复发性主动脉缩窄情况下进行BA的急性、短期和中期结果。结果指标包括残余上肢至下肢血压梯度（ULG）、抗高血压药物的使用、主动脉壁损伤、再梗阻以及再次干预的必要性。
无手术死亡。在原发性和复发性主动脉缩窄中，急性情况下，BA分别使73%-80%的患者ULG小于15 mmHg，54%-68%的患者ULG小于10 mmHg。在中期随访中，ULG进一步改善，特别是对于那些因复发性主动脉缩窄而接受初始再次干预的患者。两组在主动脉壁并发症方面无显著差异，且无干预生存期相似。血管成形术后，主动脉壁并发症无显著差异；然而，随着时间的推移，随访综合成像有所减少。
BA是主动脉缩窄急性和中期的一种安全有效的治疗方法。虽然原发性和复发性主动脉缩窄患者均发生了主动脉损伤，但在中期随访中，原发性主动脉缩窄初始干预患者中动脉瘤更为常见。
