Heger M, Gabriel H, Koller-Strametz J, Atteneder M, Frank H, Baumgartner H, Wollenek G, Wimmer M, Huber K
Universitätsklinik für Innere Medizin II Klinische Abteilung für Kardiolgie, Wien, Osterreich.
Z Kardiol. 1997 Jan;86(1):50-5. doi: 10.1007/s003920050033.
Surgical repair of coarctation of the aorta has been performed since 1945. Although surgical techniques have improved, problems such as restenosis and aneurysm at the operation site or hypertensive cardiovascular disease, still remain. To evaluate the long-term results after surgical repair of coarctation, 41 patients, 25 male and 16 female patients (mean age: 28 +/- 11 years, range 14-57 years), were studied 16 +/- 8 years after surgery (range 3-44 years). Mean age at surgery was 12 +/- 9 years (range 0.5-35 years). In 24 patients resection and end-to-end anastomosis had been performed, patch graft aortoplasty in nine patients, tube interposition graft in seven patients and one patient had undergone the subclavian flap technique. All patients were assessed by exact physical examination, the resting arm-to-leg systolic pressure gradient was measured by Doppler sonography, a bicycle exercise test and an echocardiogram were performed. Twenty-one patients reported postoperative symptoms such as dizziness (n = 12), headache (n = 3), cold legs (n = 10) and/or dyspnea (n = 8). In two patients the resting arm-to-leg pressure gradient was greater than 30 mm Hg, in two patients it was greater than 20 mm Hg. Gradient calculated by Doppler echocardiography ranged from 0 to 80 mm Hg (21 +/- 17 mm Hg) and showed poor correlation with the arm-to-leg pressure difference. The mean functional capacity was 89 +/- 18% (range 42-110%). In 18 patients exercise-induced hypertension was found, while in only eight patients arterial hypertension had already been known. To evaluate the morphology of the aorta MRI was performed in 28 patients. No aneurysm was found. In five patients a minimal lumen diameter as small as 9-11 mm was measured. Patients were divided into two groups according to their age at operation, group I: < 9 years (n = 19) and group II: > 9 years (n = 22). Resting blood pressure was significantly higher in group II (135 +/- 27 mm Hg vs 114 +/- 20 mm Hg, p < 0.009), anti-hypertensive medication (43% vs 11%, p < 0.04) and symptoms were more frequent in these patients (15/22 vs 6/19, p < 0.04). However at time of follow-up examination the age of patients of group II was significantly higher (33 +/- 12 vs 22 +/- 5 years, p < 0.0005). Between these two groups there was no difference in follow-up time and results of echocardiography or stress test. In conclusion, despite good long-term results after surgical repair of coarctation of the aorta, patients should be followed on a regular basis primarily in order to recognize systemic hypertension as early as possible and to improve the long-term outcome in these patients by antihypertensive treatment.
自1945年以来，一直开展主动脉缩窄的外科修复手术。尽管手术技术有所改进，但诸如手术部位再狭窄和动脉瘤或高血压性心血管疾病等问题仍然存在。为了评估主动脉缩窄外科修复术后的长期效果，对41例患者进行了研究，其中男性25例，女性16例（平均年龄：28±11岁，范围14 - 57岁），这些患者在术后16±8年（范围3 - 44年）接受了随访。手术时的平均年龄为12±9岁（范围0.5 - 35岁）。24例患者进行了切除和端端吻合术，9例患者进行了补片移植主动脉成形术，7例患者进行了管状移植术，1例患者接受了锁骨下皮瓣技术。所有患者均接受了详细的体格检查，通过多普勒超声测量静息时的臂 - 腿收缩压梯度，进行了自行车运动试验和超声心动图检查。21例患者报告了术后症状，如头晕（n = 12）、头痛（n = 3）、下肢发冷（n = 10）和/或呼吸困难（n = 8）。2例患者静息时的臂 - 腿压力梯度大于30 mmHg，2例患者大于20 mmHg。通过多普勒超声心动图计算的梯度范围为0至80 mmHg（21±17 mmHg），与臂 - 腿压力差的相关性较差。平均功能能力为89±18%（范围42 - 110%）。18例患者发现运动诱发的高血压，而只有8例患者之前已被诊断为动脉高血压。为了评估主动脉的形态，对28例患者进行了MRI检查。未发现动脉瘤。5例患者测量到最小管腔直径小至9 - 11 mm。根据手术时的年龄将患者分为两组，I组：<9岁（n = 19）和II组：>9岁（n = 22）。II组的静息血压明显更高（135±27 mmHg对114±20 mmHg，p < 0.009），服用抗高血压药物的比例更高（43%对11%，p < 0.04），这些患者的症状也更频繁（15/22对6/19，p < 0.04）。然而，在随访检查时，II组患者的年龄明显更大（33±12对22±5岁，p < 0.0005）。这两组之间在随访时间以及超声心动图或负荷试验结果方面没有差异。总之，尽管主动脉缩窄外科修复术后有良好的长期效果，但仍应定期对患者进行随访，主要是为了尽早识别系统性高血压，并通过抗高血压治疗改善这些患者的长期预后。
