Shirali G S, Cephus C E, Kuhn M A, Ogata K K, Vander Dussen L K, Chinnock R E, Mulla N F, Johnston J K, Bailey L L, Gundry S R, Razzouk A J, Larsen R L
Department of Pediatrics, Loma Linda University Children's Hospital, California, USA.
J Am Coll Cardiol. 1998 Aug;32(2):509-14. doi: 10.1016/s0735-1097(98)00235-6.
This study was undertaken to investigate the incidence of posttransplant recoarctation of the aorta, delineate the mode of presentation, identify risk factors that predict recoarctation and examine the results of intervention for posttransplant recoarctation.
Patients with aortic arch hypoplasia require extended arch reconstruction at transplant, with an inherent possibility of subsequent recoarctation of the aorta.
This was a retrospective review of all children (age <18 years) who underwent cardiac transplantation over a 10-year period. Collected data included pretransplant diagnosis, details of the transplant procedure and posttransplant data including development of recoarctation of the aorta, interventions for recoarctation and the most recent follow-up assessment of the aortic arch.
Two hundred eighty-eight transplants were performed on 279 children (follow-up = 1,075 patient-years; range 0 to 133 months, median 43.7). Thirty-two of 152 patients (21%) who underwent extended aortic arch reconstruction subsequently developed recoarctation. All but one patient developed recoarctation within 2 years after transplant; 87% were hypertensive at presentation. Of 30 patients who underwent intervention for recoarctation (balloon angioplasty [n = 26] and surgical repair of recoarctation [n = 4]), 26 (87%) have remained recurrence-free (follow-up = 133 patient-years; range 8 to 106 months, median 47).
The high frequency of recoarctation after cardiac transplantation with extended aortic arch reconstruction mandates serial echocardiographic evaluation of the aortic arch. Patients typically present with systemic hypertension within the first two years after transplantation. Balloon angioplasty is a safe, effective and durable method of treatment.
本研究旨在调查心脏移植术后主动脉再缩窄的发生率，描述其表现形式，确定预测再缩窄的危险因素，并研究心脏移植术后主动脉再缩窄的干预结果。
主动脉弓发育不全的患者在心脏移植时需要进行扩大的主动脉弓重建，术后存在主动脉再缩窄的内在可能性。
这是一项对10年间接受心脏移植的所有18岁以下儿童的回顾性研究。收集的数据包括移植前诊断、移植手术细节以及移植后数据，包括主动脉再缩窄的发生情况、再缩窄的干预措施以及主动脉弓的最新随访评估。
对279名儿童进行了288例心脏移植（随访时间 = 1075患者年；范围0至133个月，中位数43.7个月）。152例接受扩大主动脉弓重建的患者中有32例（21%）随后发生了再缩窄。除1例患者外，所有患者均在移植后2年内发生再缩窄；87%的患者在出现症状时患有高血压。在30例接受再缩窄干预的患者中（球囊血管成形术[n = 26]和再缩窄手术修复[n = 4]），26例（87%）未再复发（随访时间 = 133患者年；范围8至106个月，中位数47个月）。
心脏移植并进行扩大主动脉弓重建后再缩窄的发生率很高，因此必须对主动脉弓进行系列超声心动图评估。患者通常在移植后的头两年内出现全身性高血压。球囊血管成形术是一种安全、有效且持久的治疗方法。
