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1 岁以下儿童复发主动脉缩窄球囊血管成形术的即刻和中期结果。

Immediate and midterm results of balloon angioplasty for recurrent aortic coarctation in children aged<1 year.

机构信息

Paediatric cardiology, Gatien-de-Clocheville children's hospital, university hospital of Tours, 37044 Tours, France; François-Rabelais university, 37000 Tours, France; Inserm UMR 1069, 37000 Tours, France.

Cardiology, institut du thorax, university hospital of Nantes, 44000 Nantes, France.

出版信息

Arch Cardiovasc Dis. 2018 Mar;111(3):172-179. doi: 10.1016/j.acvd.2017.05.007. Epub 2017 Oct 10.

DOI:10.1016/j.acvd.2017.05.007
PMID:29030063
Abstract

BACKGROUND

Several publications have considered results of percutaneous angioplasty for aortic recoarctation, but none focused on procedures performed in children aged<1 year.

AIMS

To describe the immediate and midterm results of balloon angioplasty for recoarctation before the age of 1 year, and to define the factors that might influence outcome.

METHODS

We retrospectively reviewed data from 20 consecutive children undergoing percutaneous dilatation for aortic recoarctation before the age of 1 year in the University Hospitals of Tours and Nantes.

RESULTS

In all patients except one, dilatation improved the median recoarctation diameter Z-score from -5.5 (range -10.6 to -2.5) to -2.8 (range -4.3 to 0.7) (P<0.001), and reduced the median peak systolic gradient from 33mmHg (range 20 to 60mmHg) to 21mmHg (range 6 to 50mmHg) (P<0.001). There was no procedure-induced mortality and no acute intimal flap or long-term aneurysm. Three patients experienced a transient femoral artery thrombosis, one of whom had a transient ischemic stroke. Eight children (40%) needed reintervention for further recoarctation (new surgery [n=4] or new dilatation [n=4]). A smaller balloon size was significantly associated with the risk of reintervention: balloon to recoarctation diameter ratio 2.0 (range 1.3 to 3.3) vs. 2.7 (range 2.1 to 4.5) (P=0.05); balloon to descending aorta ratio 0.8 (range 0.7 to 1.2) vs. 1.0 (range 0.9 to 1.3) (P<0.05).

CONCLUSIONS

In this study, percutaneous balloon angioplasty for recoarctation in young infants aged<1 year improved aortic isthmus diameter with a low incidence of adverse event. However, the rate of further intervention is high, and is associated with a smaller balloon size.

摘要

背景

已有多项出版物研究了经皮血管成形术治疗主动脉缩窄的结果,但均未关注<1 岁患儿的治疗结果。

目的

描述<1 岁患儿行经皮球囊扩张治疗主动脉缩窄的即刻和中期结果,并确定可能影响结果的因素。

方法

我们回顾性分析了在图尔和南特大学医院接受经皮扩张治疗的 20 例<1 岁主动脉缩窄患儿的数据。

结果

除 1 例患者外,所有患者的扩张治疗均使主动脉缩窄段直径 Z 评分从-5.5(范围-10.6 至-2.5)改善至-2.8(范围-4.3 至 0.7)(P<0.001),并使收缩期峰值梯度从 33mmHg(范围 20 至 60mmHg)降低至 21mmHg(范围 6 至 50mmHg)(P<0.001)。无手术相关死亡病例,也无急性血管内膜瓣或长期动脉瘤。3 例患儿发生短暂性股动脉血栓形成,其中 1 例发生短暂性脑缺血发作。8 例患儿(40%)因进一步缩窄(新手术[4 例]或新扩张[4 例])需要再次介入治疗。球囊直径与再介入风险显著相关:球囊与缩窄段直径比 2.0(范围 1.3 至 3.3)与 2.7(范围 2.1 至 4.5)(P=0.05);球囊与降主动脉直径比 0.8(范围 0.7 至 1.2)与 1.0(范围 0.9 至 1.3)(P<0.05)。

结论

在这项研究中,<1 岁婴幼儿经皮球囊扩张治疗主动脉缩窄可改善主动脉峡部直径,不良事件发生率较低。然而,再次介入治疗的发生率较高,且与球囊直径较小有关。

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