新生儿和小婴儿原发性主动脉缩窄球囊血管成形术的中期安全性和结果以及使用高压非顺应性球囊进行预扩张的初步经验。

Midterm safety and outcome of balloon angioplasty of native aortic coarctation in neonates and young infants and initial experience of prepartial dilatation using high-pressure noncompliant balloon.

作者信息

Arora Harmeet Singh, Vidya P L, Ghosh Arijit Kumar, Mishra Satish Chandra, Shouche Sachin, Sethi Brijindera Singh, Mishra Satish Kumar, Nagi Gagandeep Singh

机构信息

Department of Pediatrics and Cardiology, Army Hospital Research and Referral, New Delhi, India.

Department of Cardiology, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India.

出版信息

Ann Pediatr Cardiol. 2022 Mar-Apr;15(2):121-127. doi: 10.4103/apc.apc_197_21. Epub 2022 Aug 19.

DOI:10.4103/apc.apc_197_21

PMID:36246746

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9564400/

Abstract

BACKGROUND

Balloon angioplasty (BA) for aortic coarctation in neonates and infants remains controversial due to high recurrence rate and vascular complications.

AIM

This study aimed to determine the safety and outcome of percutaneous treatment of coarctation in neonates and infants and to share the initial experience of strategy of prepartial dilatation with high-pressure noncomplaint balloon before final targeted dilatation using low-pressure compliant balloon.

MATERIALS AND METHODS

Retrospective analysis of records of all neonates and infants aged <6 months who underwent BA either using only low-pressure balloon (Group A) or those with prepartial dilatation using high-pressure noncomplaint balloon followed by low-pressure compliant balloon (Group B) between July 2017 and February 2020 was performed. Demographic, clinical, echocardiographic, interventional, and follow-up data were collected for all.

RESULTS

A total of 51 patients (41.2% neonates) were included in the study. Median age was 1 month 14 days (60.8% girls) and mean weight was 3.6 ± 1.5 kg. The mean peak trans-coarctation gradient was 53 ± 12 (34-80) mmHg. The final pressure gradient dropped to <10 mmHg in all cases of Group B and only in 26.3% (5) patients of Group A ( < 0.001). Recoarctation rate was 25.5% (13) overall and was significantly higher in Group A patients ( < 0.001), in those with borderline/mildly hypoplastic arch ( = 0.04) and in those with postprocedure gradient between 10 and 20 mmHg ( = 0.02). Median time to re-coarctation was significantly delayed in Group B ( < 0.001). There were no major complications or mortality in either group.

CONCLUSIONS

BA in neonates and young infants has an excellent short and mid-term safety and efficacy. The recoarctation rate is significantly reduced as well as delayed with prepartial dilatation using high-pressure noncompliant balloon.

摘要

背景

由于高复发率和血管并发症，新生儿和婴儿主动脉缩窄的球囊血管成形术（BA）仍存在争议。

目的

本研究旨在确定新生儿和婴儿经皮治疗主动脉缩窄的安全性和结果，并分享在使用低压顺应性球囊进行最终靶向扩张之前，采用高压非顺应性球囊进行预部分扩张策略的初步经验。

材料与方法

对2017年7月至2020年2月期间所有年龄小于6个月、仅使用低压球囊进行BA的新生儿和婴儿（A组），以及那些先使用高压非顺应性球囊进行预部分扩张，然后使用低压顺应性球囊的新生儿和婴儿（B组）的记录进行回顾性分析。收集了所有患者的人口统计学、临床、超声心动图、介入和随访数据。

结果

本研究共纳入51例患者（41.2%为新生儿）。中位年龄为1个月14天（60.8%为女孩），平均体重为3.6±1.5kg。平均跨缩窄峰值梯度为53±12（34 - 80）mmHg。B组所有病例的最终压力梯度均降至<10mmHg，而A组仅26.3%（5例）患者如此（<0.001）。总体再缩窄率为25.5%（13例），A组患者的再缩窄率显著更高（<0.001），在主动脉弓边缘/轻度发育不良的患者中（=0.04）以及术后梯度在10至20mmHg之间的患者中（=0.02）也是如此。B组再缩窄的中位时间显著延迟（<0.001）。两组均无重大并发症或死亡。