Georgescu Angela, Onorato Eustaquio, Nicolae Silvia, Balnescu Serban
Department of Cardiology, Monza Hospital, Bucharest, Romania.
Cardiovascular Department, Humanitas Gavazzeni Hospital, Bergamo, Italy.
Maedica (Bucur). 2015 Sep;10(4):342-347.
A 13 year-old boy was diagnosed with simple aortic coarctation and a bicuspid aortic valve. Ascending aorta was mildly dilated while aortic arch was smaller, but not hypoplastic. A decision to treat him was made depending on the clinical finding of systemic hypertension in his young age and a baseline trans-stenotic echographic gradient of 48 mmHg. Direct stenting with a covered Cheetham-Platinum balloon-expandable stent was performed with no complications. Despite immediate good angiographic and hemodynamic result with marked decrease of invasively measured gradient, consecutive echographic follow-up demonstrated progressive increase of the gradient in the first 9 months after the index procedure. This resulted in repeated aortic PTA with a larger balloon inside the previously implanted stent-graft. Optimal angiographic result was obtained, the patient remained symptom-free and no antihypertensive therapy was necessary thereafter. Modern treatment of simple aortic coarctation can be done in the cath-lab in appropriately selected cases. Stent implantation should be considered in all cases to avoid dissection and early elastic recoil. Long term follow-up may evidentiate the need for repeated PTA procedures in some cases.
一名13岁男孩被诊断为单纯性主动脉缩窄和二叶式主动脉瓣。升主动脉轻度扩张，而主动脉弓较小，但并非发育不全。根据其年轻时出现系统性高血压的临床发现以及经狭窄的超声心动图基线梯度为48 mmHg，决定对他进行治疗。使用带覆膜的Cheetham-铂合金球囊可扩张支架进行直接支架置入术，未出现并发症。尽管术后立即获得了良好的血管造影和血流动力学结果，侵入性测量的梯度明显降低，但连续的超声心动图随访显示，在首次手术后的前9个月，梯度逐渐增加。这导致在先前植入的支架移植物内使用更大的球囊进行重复主动脉球囊血管成形术。获得了最佳的血管造影结果，患者无症状，此后无需进行抗高血压治疗。在适当选择的病例中，单纯性主动脉缩窄的现代治疗可以在导管室进行。在所有病例中均应考虑植入支架，以避免夹层形成和早期弹性回缩。长期随访可能会发现某些病例需要重复进行球囊血管成形术。
