Yetman A T, Nykanen D, McCrindle B W, Sunnegardh J, Adatia I, Freedom R M, Benson L
Department of Pediatrics, Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada.
J Am Coll Cardiol. 1997 Sep;30(3):811-6. doi: 10.1016/s0735-1097(97)00228-3.
This study was undertaken to investigate the long-term outcome of balloon angioplasty for recurrent coarctation of the aorta in a large series of patients.
Balloon angioplasty has become the standard treatment for residual or recurrent aortic coarctation. Despite the widespread use of this treatment modality, there are few data outlining the long-term outcome of a large patient cohort.
Clinical, echocardiographic, hemodynamic and angiographic data on 90 consecutive patients who underwent balloon angioplasty between January 1984 and January 1996 were reviewed.
Mean systolic pressure gradients were reduced from 31 +/- 21 to 8 +/- 9 mm Hg after dilation (p = 0.0001). The mean diameter of the stenotic site, measured in the frontal and lateral views, increased by 38% and 35%, respectively (p = 0.001). Neurologic events occurred in two patients, with one death. An aortic tear occurred in one patient, requiring surgical intervention. Optimal results were defined as a postprocedure gradient < 20 mm Hg and were obtained acutely in 88% of patients. At long-term follow-up (12 years), 53 (72%) of 74 patients with an early optimal result remained free from reintervention. Transverse arch hypoplasia, defined as an arch dimension < 2 SD below the mean for age, was the primary predictor of the need for reintervention.
Although the majority of patients undergoing percutaneous balloon angioplasty for recoarctation of the aorta will achieve long-term benefit, the need for further surgical intervention in those with transverse arch hypoplasia remains high.
本研究旨在调查大量患者中行球囊血管成形术治疗复发性主动脉缩窄的长期疗效。
球囊血管成形术已成为残余或复发性主动脉缩窄的标准治疗方法。尽管这种治疗方式已广泛应用，但鲜有数据概述大量患者队列的长期疗效。
回顾了1984年1月至1996年1月期间连续90例行球囊血管成形术患者的临床、超声心动图、血流动力学和血管造影数据。
扩张后平均收缩压梯度从31±21降至8±9 mmHg（p = 0.0001）。在前后位和侧位测量的狭窄部位平均直径分别增加了38%和35%（p = 0.001）。两名患者发生神经系统事件，其中一例死亡。一名患者发生主动脉撕裂，需要手术干预。最佳结果定义为术后梯度<20 mmHg，88%的患者急性期即获得此结果。在长期随访（12年）中，74例早期结果最佳的患者中有53例（72%）无需再次干预。横弓发育不全定义为弓部尺寸低于年龄均值2个标准差，是再次干预需求的主要预测因素。
尽管大多数接受经皮球囊血管成形术治疗主动脉缩窄复发的患者将获得长期益处，但横弓发育不全患者仍有较高的再次手术干预需求。
