Kir Mustafa, Ugurlu Baran, Unal Nurettin, Metin Kivanç, Yilmaz Nuh, Kizilca Ozgur
Mustafa Kir, MD, Department of Pediatric Cardiology, Dokuz Eylul University Faculty of Medicine, Inciralti-Izmir 35340 Turkey.
Baran Ugurlu, MD, Department of Cardiovascular Surgery, Dokuz Eylul University Faculty of Medicine, Inciralti-Izmir 35340 Turkey.
Pak J Med Sci. 2015 Jan-Feb;31(1):131-5. doi: 10.12669/pjms.311.5531.
We have utilized subclavian flap angioplasty (SFA) frequently in infants with coarctation particularly in patients with arch hypoplasia which is quite frequent. We have followed these patients with serial echocardiography and have analyzed our results in this study to determine recoartation rates, recurrent hypertension and left arm development.
Thirty eight infants less than 3 months age (22 boys and 16 girls, mean age was 28±22.6 days) operated at Dokuz Eylul University Hospital between August 2007 - December 2013. Twelve (32%) patients with pulmonary banding due to accompanying VSD or AVSD were included to the study, those infants with complex pathologies such as transposition of great arteries or single ventricle, while the patients less than 1000 gram in weight were excluded.
The mean follow-up time was 21 months (1-76 months). Twelve (32%) patients had aortic arch hypoplasia proximal to the left subclavian artery. Operative mortality was found 7.7% for isolated coarctation, 16% for coarctation repair with pulmonary banding. In 5 patients, a residual gradient was detected and re intervention was required in 7.8% patients with balloon angioplasty.
Subclavian flap angioplasty is a safe repair technique in small infants and neonates. High gradients and intervention more likely depends on the anatomy of the aortic arch rather than the subclavian flap angioplasty technique.
我们经常在患有缩窄的婴儿中使用锁骨下皮瓣血管成形术（SFA），尤其是在主动脉弓发育不全的患者中，这种情况相当常见。我们通过连续超声心动图对这些患者进行了随访，并在本研究中分析了我们的结果，以确定再缩窄率、复发性高血压和左臂发育情况。
2007年8月至2013年12月期间，在多库兹埃于勒大学医院对38例年龄小于3个月的婴儿（22例男孩和16例女孩，平均年龄为28±22.6天）进行了手术。由于伴有室间隔缺损或房室间隔缺损而进行肺动脉环扎的12例（32%）患者被纳入研究，排除了患有诸如大动脉转位或单心室等复杂病变的婴儿，以及体重小于1000克的患者。
平均随访时间为21个月（1 - 76个月）。12例（32%）患者在左锁骨下动脉近端存在主动脉弓发育不全。单纯缩窄手术死亡率为7.7%，缩窄修复联合肺动脉环扎手术死亡率为16%。在5例患者中检测到残余压差，7.8%的患者需要进行球囊血管成形术再次干预。
锁骨下皮瓣血管成形术是一种适用于小婴儿和新生儿的安全修复技术。高压差和再次干预更可能取决于主动脉弓的解剖结构，而非锁骨下皮瓣血管成形术技术。
