Wozniak G, Bauer J, Bohle R M, Dapper F
Department of Cardiovascular Surgery, Justus-Liebig-University, Giessen, Germany.
J Cardiovasc Surg (Torino). 1998 Aug;39(4):483-8.
Compared to coarctation in the proximal descending aorta near the insertion of the ligamentum arteriosum, coarctation in the aortic arch, the lower descending or the abdominal aorta is a relatively rare disease. Operative treatment of abdominal coarctation is more complicated if there are concomitant stenoses of visceral or renal arteries. In young patients, surgical procedure and outcome is additionally determined by caliber and compliance mismatch between still growing native vessels and arterial substitute. Our report deals with a seven-year-old male patient, who was first diagnosed as having coarctation of the aorta at five years of age due to distinct bilateral brachial hypertension. The angiogram revealed a narrowing of the aorta, approximately ten centimeters in length, from the lower descending segment down to the proximal abdominal part of the aorta. The origin of the superior mesenteric artery and both renal arteries were not involved in the pathological process. Arterial reconstruction was carried out by anastomosis of cryopreserved arterial homograft with the thoracic aorta and with the abdominal aorta distal to the origin of the renal arteries. The postoperative course was uneventful, duplex sonography revealed no pressure gradient between the thoracic and abdominal aorta and brachial blood pressure was within normal ranges.
与动脉韧带附着处附近的降主动脉近端缩窄相比，主动脉弓、降主动脉下段或腹主动脉缩窄是一种相对罕见的疾病。如果伴有内脏或肾动脉狭窄，腹主动脉缩窄的手术治疗会更加复杂。在年轻患者中，手术方式和结果还取决于仍在生长的自身血管与动脉替代物之间的管径和顺应性不匹配。我们的报告涉及一名7岁男性患者，他在5岁时因明显的双侧肱动脉高血压首次被诊断为主动脉缩窄。血管造影显示主动脉从降主动脉下段到腹主动脉近端有一段约10厘米长的狭窄。肠系膜上动脉和双侧肾动脉的起始处未参与病理过程。通过将冷冻保存的同种异体动脉与胸主动脉以及肾动脉起始部远端的腹主动脉进行吻合来进行动脉重建。术后过程顺利，双功超声检查显示胸主动脉和腹主动脉之间无压力梯度，肱动脉血压在正常范围内。
