Sandoval Juan Pablo, Kang Sok-Leng, Lee Kyong-Jin, Benson Lee, Asoh Kentaro, Chaturvedi Rajiv R
Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, The Labatt Family Heart Centre, University of Toronto School of Medicine, Canada.
Circ Cardiovasc Interv. 2020 Nov;13(11):e008938. doi: 10.1161/CIRCINTERVENTIONS.120.008938. Epub 2020 Nov 10.
Balloon angioplasty for native coarctation of the aorta (CoA) is successful in children and adults but in neonates results in frequent restenosis. The efficacy of balloon angioplasty for native CoA during infancy beyond the neonatal period was examined in infants aged 3 to 12 months of age.
A retrospective review of 68 infants who underwent balloon angioplasty for native CoA. 95% CI are in parentheses.
Procedural age was (mean±SD) 6±3.4 months and weight was 7±1.8 kg. Balloon angioplasty produced a large decrease in both the noninvasive arm-to-leg blood pressure gradient (41.2±18.7 to 5.6±9.6 mm Hg) and the invasive peak systolic pressure gradient (34±12 to 11±9 mm Hg). Balloon angioplasty increased the CoA diameter from 2.7±1 mm to 4.6±1.2 mm. One patient was lost to follow-up. A catheter reintervention was required in 11.8% and surgery in 10.3%. The hazard of reintervention was highest early. Median freedom from reintervention was 89% (95% CI, 80%-96%) at 1 year, 83% (95% CI, 73%-92%) at 5 years, and 81% (95% CI, 69%-90%) at 10 years. Femoral artery thrombosis was documented in 6 (9%) infants without any long-term consequence. One patient developed a small aortic aneurysm late and has not required treatment. A robust estimate of the frequency of aortic aneurysms remains to be determined as the majority of subjects have not had cross-sectional imaging.
Balloon angioplasty of native CoA is effective and safe in infants aged 3 to 12 months with outcomes comparable to those in older children and adults. Catheter reinterventions can avoid the need for surgery in most patients.
主动脉缩窄（CoA）的球囊血管成形术在儿童和成人中取得成功，但在新生儿中常导致再狭窄。本研究对3至12个月大的婴儿进行了球囊血管成形术治疗CoA的疗效研究。
回顾性分析68例接受CoA球囊血管成形术的婴儿。括号内为95%置信区间。
手术年龄（均值±标准差）为6±3.4个月，体重为7±1.8 kg。球囊血管成形术使无创性的手臂至腿部血压梯度大幅下降（从41.2±18.7降至5.6±9.6 mmHg），以及有创性的收缩压峰值梯度（从34±12降至11±9 mmHg）。球囊血管成形术使CoA直径从2.7±1 mm增加到4.6±1.2 mm。1例患者失访。11.8%的患者需要导管再次干预，10.3%的患者需要手术。再次干预的风险在早期最高。1年时无再次干预的中位自由度为89%（95% CI，80%-96%），5年时为83%（95% CI，73%-92%），10年时为81%（95% CI，69%-90%）。6例（9%）婴儿记录有股动脉血栓形成，但无任何长期后果。1例患者后期出现小的主动脉瘤，尚未需要治疗。由于大多数受试者未进行横断面成像，主动脉瘤发生频率的可靠估计仍有待确定。
球囊血管成形术治疗CoA对3至12个月大的婴儿有效且安全，其结果与大龄儿童和成人相当。导管再次干预可避免大多数患者进行手术。
