Sánchez G R, Balsara R K, Dunn J M, Mehta A V, O'Riordan A C
J Thorac Cardiovasc Surg. 1986 May;91(5):738-46.
Recoarctation is a problem in some patients after subclavian flap aortoplasty. To investigate the reason for recoarctation, we reviewed the records of 26 infants who underwent subclavian flap repair for symptomatic coarctation of the aorta at less than 3 months of age between June, 1979, and December, 1983. Age at repair ranged from 2 to 65 days (median 16 days) and weight from 2.1 to 4.9 kg (median 3.4 kg). In 14 patients the coarctation was associated with significant intracardiac defects (complex in six). There were two intraoperative deaths and one early death (surgical mortality 12%). The survivors were followed from 6 weeks to 66 months (median 12 months). Five survivors (22%), all operated on at less than 14 days of age, developed severe recoarctation 6 weeks to 6 months (median 5 months) after repair. The obstruction appeared to be due to lumen obliteration by shelf-life posterior wall tissue. Morphometric analysis of preoperative angiograms showed no correlation between recoarctation and distance between the left subclavian artery and the site of coarctation, length of the isthmus, diameter of the isthmus, combined cross-sectional area of the left subclavian artery and isthmus, or the ratio of the combined cross-sectional area of the left subclavian artery and isthmus to the cross-sectional area of the descending thoracic aorta. Recoarctation did not correlate with weight at operation, but it correlated significantly with age at aortoplasty (p = 0.02). The results suggest that intrinsic abnormalities of the periductal aortic wall are responsible for recoarctation after subclavian flap aortoplasty. Particular attention to this abnormal tissue at repair may prevent early recurrence in young infants.
在一些接受锁骨下动脉瓣主动脉成形术的患者中，再缩窄是一个问题。为了探究再缩窄的原因，我们回顾了1979年6月至1983年12月期间26例年龄小于3个月因有症状的主动脉缩窄而接受锁骨下动脉瓣修复术的婴儿的记录。修复时的年龄为2至65天（中位数16天），体重为2.1至4.9千克（中位数3.4千克）。14例患者的缩窄与严重的心内缺陷相关（6例为复杂性缺陷）。有2例术中死亡和1例早期死亡（手术死亡率12%）。存活者的随访时间为6周至66个月（中位数12个月）。5例存活者（22%），均在14日龄前接受手术，在修复后6周至6个月（中位数5个月）出现严重再缩窄。梗阻似乎是由于后壁组织的保质期导致管腔闭塞。术前血管造影的形态学分析显示，再缩窄与左锁骨下动脉与缩窄部位之间的距离、峡部长度、峡部直径、左锁骨下动脉和峡部的联合横截面积，或左锁骨下动脉和峡部的联合横截面积与降主动脉横截面积的比值之间无相关性。再缩窄与手术时的体重无关，但与主动脉成形术时的年龄显著相关（p = 0.02）。结果表明，动脉导管周围主动脉壁的内在异常是锁骨下动脉瓣主动脉成形术后再缩窄的原因。在修复时特别关注这种异常组织可能会防止幼儿早期复发。
