Poncelet Alain J, Henkens Arnaud, Sluysmans Thierry, Moniotte Stephane, de Beco Geoffroy, Momeni Mona, Detaille Thierry, Rubay Jean E
1 Department of Cardiovascular and Thoracic Surgery, Cliniques universitaires Saint-Luc, Universite catholique de Louvain, Brussels, Belgium.
2 Department of Pediatric Cardiology, Cliniques universitaires Saint-Luc, Universite catholique de Louvain, Brussels, Belgium.
World J Pediatr Congenit Heart Surg. 2018 Sep;9(5):496-503. doi: 10.1177/2150135118780611.
Several techniques have been described to correct coarctation associated with distal arch hypoplasia. However, in neonates, residual gradients are frequently encountered and influence long-term outcome. We reviewed our experience with an alternative technique of repair combining carotid-subclavian angioplasty and extended end-to-end anastomosis.
From 1998 through 2014, 109 neonates (median age, 9 days) with coarctation and distal arch hypoplasia (n = 106) or type A interrupted aortic arch (n = 3) underwent repair using this technique. Thirty patients had isolated lesions (group 1), 44 associated ventricular septal defect (group 2), and 35 associated complex cardiac lesions (group 3). Median follow-up was 98 months.
Repair was performed via left thoracotomy in 97%. There was one procedural-related death (0.9%) and overall five patients died during index admission (4.6%). Ten deaths were recorded at follow-up. Actuarial five-year survival was 86% (100% in group 1, 91% group 2, and 66% in group 3). Recurrent coarctation (clinical or invasive gradient >20 mm Hg) developed in 15 patients, all but 2 successfully treated by balloon dilatation. Freedom from any reintervention (dilatation or surgery) at five years was 86%. Only two patients were on antihypertensive drugs at last follow-up.
This combined technique to correct distal arch hypoplasia and isthmic coarctation results in low mortality and acceptable recurrence rate. It preserves the left subclavian artery and allows enlargement of the distal arch diameter. Late outcome is excellent with very low prevalence of late arterial hypertension.
已有多种技术用于矫正与主动脉弓远端发育不全相关的缩窄。然而，在新生儿中，残余压差经常出现并影响长期预后。我们回顾了我们采用颈动脉-锁骨下动脉血管成形术联合扩大端端吻合术这种替代修复技术的经验。
1998年至2014年，109例患有缩窄合并主动脉弓远端发育不全（n = 106）或A型主动脉弓中断（n = 3）的新生儿（中位年龄9天）采用该技术进行修复。30例患者为孤立性病变（1组），44例合并室间隔缺损（2组），35例合并复杂心脏病变（3组）。中位随访时间为98个月。
97%的患者通过左胸切口进行修复。有1例与手术相关的死亡（0.9%），共有5例患者在首次住院期间死亡（4.6%）。随访期间记录到10例死亡。5年实际生存率为86%（1组为100%，2组为91%，3组为66%）。15例患者出现复发性缩窄（临床或有创测量压差>20 mmHg），除2例患者外，其余均通过球囊扩张成功治疗。5年无任何再次干预（扩张或手术）的比例为86%。最后一次随访时只有2例患者服用降压药。
这种矫正主动脉弓远端发育不全和峡部缩窄的联合技术导致死亡率低且复发率可接受。它保留了左锁骨下动脉，并使主动脉弓远端直径增大。晚期预后良好，晚期动脉高血压患病率极低。
