McCrossan Brian, Nolke Lars, Kenny Damien, Oslizlok Paul, Crispino Gloria, Walsh Kevin P, McMahon Colin J
Department of Paediatric Cardiology, Our Lady's Children's Hospital, Crumlin, Dublin 12, Ireland.
Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland.
Cardiol Young. 2019 Sep;29(9):1137-1142. doi: 10.1017/S1047951119001549. Epub 2019 Jul 24.
Recurrent aortic arch obstruction following the Norwood procedure is recognised as an important complication. Balloon arch angioplasty is associated with a high recoarctation rate.
We sought to evaluate the prevalence and outcome of stent implantation for recoarctation in children following Norwood or Damus-Kaye-Stansel procedure over the past decade at a single national cardiology centre.
Of 114 children who underwent Norwood procedure or Damus-Kaye-Stansel procedure between January 2003 and June 2013, 80 patients survived. Of these 15 children underwent stent implantation for recoarctation. Six of these patients had previous balloon angioplasty. The median age at stent implantation was 4.4 months (range 2-82 months). The median peak aortic arch gradient at catheterisation decreased from 26mmHg (range 10-70mmHg) to 2mmHg (range 0-20mmHg). The median luminal diameter increased from 4.7 mm (range 3.2-7.9 mm) to 8.6 mm (range 6.2-10.9 mm). The median coarctation index increased by 0.49 (range = 0.24-0.64). A Valeo stent was employed in 11 children, a Palmaz Genesis stent in 2 patients, a MultiLink stent in 1 child, and a Jomed covered stent in 1 child. Two factors were associated with the need for stent placement: previous arch angioplasty (p valve < 0.001, χ-square 11.5) and borderline left ventricle (p = 0.04, χ-square = 4.1). Stent migration occurred in one child. There were two deaths related to poor right ventricular systolic function and severe tricuspid regurgitation. Six patients underwent redilation of the stent with no complications.
The prevalence of recurrent aortic arch obstruction following Norwood/Damus-Kaye-Stansel procedure was 18%. Stent implantation is safe and reliably eliminates the aortic obstruction. Redilation can be successfully achieved to accommodate somatic growth or development of stent recoarctation.
诺伍德手术后继发性主动脉弓梗阻被认为是一种重要的并发症。球囊主动脉弓血管成形术的再缩窄率较高。
我们试图评估在过去十年中，在一个国家心脏病中心，接受诺伍德手术或达穆斯-凯-斯坦塞尔手术的儿童因再缩窄而进行支架植入的发生率及结果。
在2003年1月至2013年6月期间接受诺伍德手术或达穆斯-凯-斯坦塞尔手术的114名儿童中，80名患者存活。其中15名儿童因再缩窄接受了支架植入。这些患者中有6名曾接受过球囊血管成形术。支架植入时的中位年龄为4.4个月（范围2 - 82个月）。导管插入术时主动脉弓的中位峰值梯度从26mmHg（范围10 - 70mmHg）降至2mmHg（范围0 - 20mmHg）。中位管腔直径从4.7mm（范围3.2 - 7.9mm）增加到8.6mm（范围6.2 - 10.9mm）。中位缩窄指数增加了0.49（范围 = 0.24 - 0.64）。11名儿童使用了Valeo支架，2名患者使用了Palmaz Genesis支架，1名儿童使用了MultiLink支架，1名儿童使用了Jomed覆膜支架。两个因素与需要放置支架有关：既往主动脉弓血管成形术（p值 < 0.001，卡方值11.5）和临界左心室（p = 0.04，卡方值 = 4.1）。1名儿童发生了支架移位。有2例死亡与右心室收缩功能差和严重三尖瓣反流有关。6名患者对支架进行了再次扩张，无并发症发生。
诺伍德/达穆斯-凯-斯坦塞尔手术后复发性主动脉弓梗阻的发生率为18%。支架植入安全且能可靠地消除主动脉梗阻。可以成功进行再次扩张以适应身体生长或支架再缩窄的发展。
