Pediatric Cardiac Surgical Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Chin Med J (Engl). 2017 Dec 5;130(23):2802-2807. doi: 10.4103/0366-6999.215279.
Coarctation of the aorta (CoA) with aortic arch hypoplasia (AAH) is a relatively common congenital heart disease in clinical practice. Nonetheless, the corrective surgical technique for infants and children is a clinical problem that remains controversial. In this study, we sought to evaluate the surgical effects of aortic arch (AA) reconstruction with coarctation resection and aortoplasty with autologous pulmonary artery patch for infants and young children with CoA and AAH.
Between January 2009 and December 2015, a total of 22 infants and young children with CoA and AAH who underwent coarctation resection and aortoplasty with autologous pulmonary artery patch were enrolled in this study. The median age of patients was 4.5 (Q1, Q3: 2.0, 14.0) months and the median body weight was 5.75 (Q1, Q3: 4.10, 9.38) kg. All patients were diagnosed with CoA and AAH, and concomitant cardiac anomalies were corrected in one stage. Perioperative and postoperative data were collected and analyzed using the paired sample t-test.
No perioperative deaths occurred. No residual obstruction was detected by echocardiography. The postoperative pressure difference across the repaired segment of CoA was 14.05 ± 4.26 mmHg (1 mmHg = 0.133 kPa), which was smaller than the preoperative pressure difference (48.30 ± 15.73 mmHg; t = -10.119, P < 0.001). The median follow-up time was 29.0 (Q1, Q3: 15.5, 57.3) months. There was no death during the follow-up period, and all patients experienced obvious clinical improvement. Only one child underwent subsequent aortic balloon angioplasty due to restenosis. Computed tomography angiography showed that the AA morphology was smooth, with no aortic aneurysm or angulation deformity.
AA reconstruction with coarctation resection and aortoplasty with autologous pulmonary artery patch could effectively correct CoA with AAH, and the rate of reintervention for restenosis is low.
主动脉缩窄（CoA）伴主动脉弓发育不良（AAH）是临床实践中较为常见的先天性心脏病。然而，对于婴幼儿，其矫正手术技术是一个存在争议的临床问题。本研究旨在评估 CoA 合并 AAH 患儿行缩窄段切除和自体肺动脉补片主动脉成形术的手术效果。
2009 年 1 月至 2015 年 12 月，共纳入 22 例行缩窄段切除和自体肺动脉补片主动脉成形术的 CoA 合并 AAH 婴幼儿患者。患者的中位年龄为 4.5（Q1，Q3：2.0，14.0）个月，中位体质量为 5.75（Q1，Q3：4.10，9.38）kg。所有患者均诊断为 CoA 合并 AAH，同期行合并心脏畸形矫治。收集并分析围手术期和术后数据，采用配对样本 t 检验。
无围手术期死亡。超声心动图检查未见残余狭窄。CoA 修复段的术后压力差为 14.05 ± 4.26mmHg（1mmHg=0.133kPa），小于术前压力差（48.30 ± 15.73mmHg；t=-10.119，P＜0.001）。中位随访时间为 29.0（Q1，Q3：15.5，57.3）个月。随访期间无死亡病例，所有患者均有明显的临床改善。仅 1 例患儿因再狭窄行主动脉球囊扩张成形术。CT 血管造影显示，AA 形态良好，无主动脉瘤或角度畸形。
缩窄段切除和自体肺动脉补片主动脉成形术可有效矫正 CoA 合并 AAH，且再狭窄的再次介入治疗率较低。
