Hallbergson Anna, Rome Jonathan J
Division of Cardiology, The Children's Hospital of Philadelphia, Perelman School of Medicine and the University of Pennsylvania, Philadelphia, Pennsylvania; Children's Heart Center, Skane University Hospital, Lund, 221 85, Sweden.
Catheter Cardiovasc Interv. 2015 May;85(6):1017-20. doi: 10.1002/ccd.25771. Epub 2015 Feb 3.
Percutaneous coronary artery stent angioplasty is rare in the pediatric population but can be a life-saving by rapidly reestablishing flow to an obstructed coronary artery. It is a technically challenging and high-risk procedure in infants and further limited by the need for future surgical intervention. We report of an infant with anomalous left coronary artery from the pulmonary artery who underwent acutely successful surgical reimplantation of the left coronary artery onto the ascending aorta. One month later, she developed acute myocardial ischemia and emergent catheterization diagnosed near-total occlusion of the left coronary artery. We implanted a 2.5 mm coronary stent in the left main coronary artery with reestablishment of flow. The patient's left ventricular systolic function recovered within 4 weeks and repeat angiography 3 months later showed complete normalization of the entire left coronary artery system. The patient weighed 3 kg and was < 6 weeks of age at the time of stent implantation which to our knowledge is the smallest and youngest reported patient to undergo coronary stent angioplasty. This case supports the feasibility of this procedure in infants as a temporizing solution to hemodynamic instability from myocardial ischemia due to coronary artery stenosis. The left ventricular systolic function remained normal at 7 months after stent placement and the patient was clinically well from a cardiac perspective.
经皮冠状动脉支架血管成形术在儿科人群中很少见，但通过迅速恢复阻塞冠状动脉的血流可挽救生命。在婴儿中，这是一项技术上具有挑战性且高风险的手术，并且由于未来需要手术干预而受到进一步限制。我们报告了一名患有肺动脉起源异常左冠状动脉的婴儿，该婴儿成功地进行了左冠状动脉急性手术再植入升主动脉。一个月后，她出现急性心肌缺血，紧急导管检查诊断为左冠状动脉近完全闭塞。我们在左主冠状动脉植入了一个2.5毫米的冠状动脉支架，恢复了血流。患者的左心室收缩功能在4周内恢复，3个月后重复血管造影显示整个左冠状动脉系统完全恢复正常。支架植入时患者体重3公斤，年龄小于6周，据我们所知，这是接受冠状动脉支架血管成形术报道中年龄最小、体重最轻的患者。该病例支持了该手术在婴儿中作为因冠状动脉狭窄导致心肌缺血引起的血流动力学不稳定的临时解决方案的可行性。支架置入7个月后，左心室收缩功能仍正常，从心脏角度来看，患者临床状况良好。
