Park Y, Lucas V W, Sklansky M S, Kashani I A, Rothman A
Division of Pediatric Cardiology, University of California, San Diego School of Medicine, 92103, USA.
Am Heart J. 1997 Nov;134(5 Pt 1):917-23. doi: 10.1016/s0002-8703(97)80015-4.
The use of balloon dilation to treat native aortic coarctation is controversial, particularly in infants. Between January 1991 and September 1996, 12 patients < or = 3 months of age with native coarctation of the aorta (CoA) underwent balloon angioplasty (BA). All 12 lesions were dilated successfully with a mean reduction in peak systolic gradient from 49.3 +/- 16.5 mm Hg to 6.8 +/- 4.0 mm Hg (p < 0.001) and a mean increase in minimum CoA diameter from 2.4 +/- 0.6 mm to 5.5 +/- 1.3 mm (p < 0.001). Intimal flaps or tears were detected immediately after BA in 4 (33%) of 12 patients by angiography and in 8 (89%) of 9 patients by intravascular ultrasonography. No deaths or major complications related to the BA occurred. One patient had documented asymptomatic femoral artery obstruction, and one patient with hydrops fetalis and congenital pleural effusions died with gram-negative sepsis 1 week after the procedure. Follow-up was available for 10 patients (1 was lost to follow-up) between 2 months and 4.1 years (mean 2.4 +/- 1.3 years) after BA. No patient had an aortic aneurysm. Restenosis occurred in 5 (50%) of 10 patients, requiring reintervention a mean of 2.6 +/- 2.1 months after BA. One patient underwent surgical repair. Repeat BAs were performed in the other four patients; three were successful, and one with partial gradient relief required surgical repair. Five patients have not required reintervention a mean of 2.9 +/- 1.0 years after the initial BA. Among these five patients, follow-up intravascular ultrasound performed in three patients a mean of 2.0 +/- 1.9 years after BA showed favorable endovascular remodeling. There was a tendency for early reintervention in patients < 1 month of age and coexistence of a patent ductus arteriosus at the time of BA. In conclusion, selected infants < or = 3 months of age with discrete native CoA may be treated initially with balloon dilation. Most patients who have restenosis respond successfully to repeat BA.
使用球囊扩张术治疗原发性主动脉缩窄存在争议，尤其是在婴儿中。1991年1月至1996年9月期间，12例年龄≤3个月的原发性主动脉缩窄（CoA）患者接受了球囊血管成形术（BA）。所有12处病变均成功扩张，收缩期峰值压差平均从49.3±16.5 mmHg降至6.8±4.0 mmHg（p<0.001），主动脉缩窄最小直径平均从2.4±0.6 mm增加至5.5±1.3 mm（p<0.001）。血管造影显示，12例患者中有4例（33%）在BA后立即检测到内膜瓣或撕裂，血管内超声显示9例患者中有8例（89%）出现这种情况。未发生与BA相关的死亡或重大并发症。1例患者记录有无症状股动脉阻塞，1例患有胎儿水肿和先天性胸腔积液的患者在术后1周死于革兰阴性菌败血症。10例患者（1例失访）在BA后2个月至4.1年（平均2.4±1.3年）接受了随访。无患者发生主动脉瘤。10例患者中有5例（50%）发生再狭窄，平均在BA后2.6±2.1个月需要再次干预。1例患者接受了手术修复。其他4例患者进行了重复BA；3例成功，1例压差部分缓解的患者需要手术修复。5例患者在初次BA后平均2.9±1.0年未需要再次干预。在这5例患者中，3例患者在BA后平均2.0±1.9年进行的随访血管内超声显示血管内重塑良好。年龄<1个月且在BA时存在动脉导管未闭的患者有早期再次干预的倾向。总之，选定的年龄≤3个月的离散型原发性CoA婴儿可首先用球囊扩张术治疗。大多数发生再狭窄的患者对重复BA反应成功。
