经皮球囊血管成形术治疗先天性主动脉缩窄远期随访及疗效评价  

A long-term follow-up results of percutaneous balloon angioplasty of coarctation of the aorta in children

作　　者：李奋[1] 周爱卿[1] 高伟[1] 王荣发[1] 余志庆[1] 黄美蓉[1] 杨建萍[1] 

机构地区：[1]上海第二医科大学附属上海儿童医学中心,200127

出　　处：《中国介入心脏病学杂志》2000年第4期183-185,共3页Chinese Journal of Interventional Cardiology

摘　　要：目的　总结经皮球囊血管成形术治疗先天性主动脉缩窄随访结果 ,以评价该介入方法的长期疗效及影响疗效的因素。方法　 1987年 9月至 1999年 8月 ,我院共有 2 4例先天性主动脉缩窄患儿接受了 2 7次经皮球囊血管成形术治疗 ,其中 19例为局限性峡部缩窄 (隔膜型 ) ,4例为主动脉弓发育不良型 ,1例为手术后再狭窄。选择的球囊直径一般不超过缩窄段近端主动脉直径 (11 0 6±2 80 )mm与 (11 78± 3 18)mm ,球囊 缩窄段之比为 2～ 4(平均 2 5 7± 0 6 8)。术后随访 6个月～ 12年 ,平均 (6 2± 2 8)年。跨缩窄段压差≤ 2 0mmHg(1mmHg =0 133kPa)为疗效良好。结果　术后跨缩窄段压差由 (4 8 2± 14 7)mmHg下降至 (15 0± 13 1)mmHg(P <0 0 1) ,缩窄段直径由 (4 7± 2 4)mm增加至 (8 8± 3 3)mm(P <0 0 1)。 19例 (79% )即刻疗效良好。 5例疗效不良患儿中 ,4例为主动脉弓发育不良型 ,1例为隔膜型。 19例疗效良好患儿中 ,18例为隔膜型 ,1例为手术后再狭窄。 1例隔膜型初次疗效良好的患儿随访中压差上升至 30mmHg ,2年半后接受第二次扩张术并获良好疗效 ;1例发育不良型患儿即刻疗效不佳 ,7年后再次行扩张术但疗效仍不理想 ;1例隔膜型但初次疗效不佳的患儿7年后再次行扩张术获良好效果。随访中无动脉瘤及?Objectives A 12 year follow up results of percutaneous balloon angioplasty of coarctation of the aorta in children were studied to evaluate its efficiency and discuss risk factors for a long term result Methods From September 1987 to August 1999, 24 patients underwent 27 balloon angioplasty procedures for native or recurrent coarctation of the aorta at our institution The coarctation was discrete (membranous) in 19 patients, long segment and aortic arch hypoplasia in 4 patients, and recurrent postoperative in 1 patient The balloon diameter was chosen not to exceed the diameter of the aorta proximal to the stenotic site (11 06±2 80) mm versus (11 78±3 18) mm, with the chosen diameter two to four times that of the stenotic segment (2 57±0 68) times The patients have been followed up for half to twelve years (mean 6 2±2 8 years) Satisfactory result was defined as a reduction in the pressure gradient across the site of coarctation to ≤20 mm?Hg Results The systolic pressure gradient across the coarctation site decreased from (48 2±14 7)mm?Hg to (15 0±13 1)mm?Hg ( P <0 01) and the diameter of the coarctation site increased from (4 7±2 4)mm to (8 8±3 3)mm ( P <0 01) An immediate satisactory result was obtained in 19 patients (79%) Of the 5 patients with an unsatisfactory result, 4 had aortic arch hypoplasia and 1 had membranous coarctation Of 19 patients with satisfactory result, 18 patients had membranous coarctation and 1 patient recurrent postoperative coarctation No aneurysm and other complications occurred in all patients at follow up Conclusion Percutaneous balloon angioplasty is an effective treatment alternative to surgery in most patients with recurrent postoperative or native membranous coarctation of the aorta It shouldn't be recommended for the coarctation of aortic arch hypoplasia

关 键 词：主动脉缩窄 血管成形术 经腔 

分 类 号：R654.205[医药卫生—外科学]