Kaine S F, Smith E O, Mott A R, Mullins C E, Geva T
Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Houston, USA.
Circulation. 1996 Sep 1;94(5):1056-62. doi: 10.1161/01.cir.94.5.1056.
The use of balloon angioplasty for treatment of native aortic coarctation is controversial. Cineangiographic data suggest that aortic arch hypoplasia and isthmic narrowing are associated with angioplasty failure. This study of echocardiographic measurements of preangioplasty aortic arch morphology was performed to identify potential anatomic predictors of outcome noninvasively.
The preangioplasty echocardiograms of 105 patients 3 days to 17 years old with native coarctation of the aorta were analyzed off-line. Angioplasty was considered successful if the residual coarctation gradient was < 20 mm Hg and no intervention for recoarctation occurred. Univariate analysis identified young age at angioplasty, presence of a patent ductus arteriosus, and the diameters of the aortic isthmus, distal transverse arch, and aortic valve as predictors of early and late outcomes. Multivariate analysis showed that the preangioplasty aortic isthmus z value was the best independent predictor of outcome, eliminating the effect on outcome of age and associated cardiac defects. An isthmus z value < or = -2.16 predicted early failure with 91% sensitivity and 85% specificity. Kaplan-Meier analysis demonstrated that 90% of patients with an isthmus z value > -1.0 remained free of recoarctation at late follow-up, whereas 89% of patients with a preangioplasty isthmus z value < or = -2.0 developed recoarctation within 36 months.
Echocardiographic measurements of the aortic arch predict both early and late outcomes of balloon angioplasty for native aortic coarctation, and the preangioplasty aortic isthmus z value was the best independent predictor. Quantitative aortic arch analysis may improve selection of angioplasty candidates who are likely to benefit from the procedure.
使用球囊血管成形术治疗原发性主动脉缩窄存在争议。电影血管造影数据表明，主动脉弓发育不全和峡部狭窄与血管成形术失败有关。本研究通过超声心动图测量血管成形术前主动脉弓形态，旨在无创识别可能的解剖学预后预测因素。
对105例年龄在3天至17岁的原发性主动脉缩窄患者血管成形术前的超声心动图进行离线分析。如果残余缩窄梯度<20mmHg且未进行再缩窄干预，则血管成形术被认为成功。单因素分析确定血管成形术时年龄小、动脉导管未闭的存在以及主动脉峡部、远端横弓和主动脉瓣直径是早期和晚期预后的预测因素。多因素分析表明，血管成形术前主动脉峡部z值是预后的最佳独立预测因素，消除了年龄和相关心脏缺陷对预后的影响。峡部z值≤-2.16预测早期失败的敏感性为91%，特异性为85%。Kaplan-Meier分析表明，峡部z值>-1.0的患者在晚期随访中90%无再缩窄，而血管成形术前峡部z值≤-2.0的患者89%在36个月内发生再缩窄。
超声心动图测量主动脉弓可预测原发性主动脉缩窄球囊血管成形术的早期和晚期预后，血管成形术前主动脉峡部z值是最佳独立预测因素。定量主动脉弓分析可能有助于改善对可能从该手术中获益的血管成形术候选者的选择。
