经皮球囊扩张式覆膜支架置入治疗先天性主动脉缩窄的临床疗效分析  

Clinical efficacy of percutaneous balloon dilatation covered stent implantation for congenital coarctation of the aorta

作　　者：金屏 刘洋 唐嘉佑 符显明 金振晓 金艳 杨剑 俞世强 Jin Ping;Liu Yang;Tang Jiayou;Fu Xianming;Jin Zhenxiao;Jin Yan;Yang Jian;Yu Shiqiang(Department of Cardiovascular Surgery,Xijing Hospital,Air Force Military Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院心血管外科,西安710032 [2]中南大学湘雅二医院心脏大血管外科,长沙410011

出　　处：《中国体外循环杂志》2018年第6期366-368,374,共4页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金(81570231;81774415;81500319)

摘　　要：目的评价经皮球囊扩张式覆膜支架置入治疗青少年及成人先天性主动脉缩窄(Co A)的安全性和有效性。方法回顾性分析2010年1月至2017年12月期间在空军军医大学西京医院心血管外科接受经皮球囊扩张式覆膜支架置入术的20例先天性主动脉缩窄患者。男14例,女6例,年龄(27.68±13.45)岁。2例合并动脉导管未闭(PDA)和室间隔缺损(VSD)。收集并分析患者住院和随访期间的相关临床资料。结果 20例Co A患者均成功实施经皮球囊扩张式覆膜支架置入治疗。每位患者Co A处经股动脉植入覆膜支架一枚,Co A处最窄平均直径由术前(4.35±2.61) mm增至术后即刻(16.84±1.99)mm(P <0.05),平均跨缩窄收缩压压差由术前(81.29±18.72) mm Hg下降至术后(15.52±7.47) mm Hg(P <0.05)。平均右上肢收缩压由术前(182.05±38.99) mm Hg下降至术后(141.95±32.11) mm Hg(P <0.05);平均下肢动脉收缩压由术前(121.52±27.84) mm Hg上升至术后(131.81±32.39) mm Hg(P <0.05)。合并PDA和VSD的2例患者同期行介入封堵术,术后无分流。患者术后住院及随访期间,末见明显相应心血管并发症发生。结论经皮球囊扩张式覆膜支架置入治疗青少年及成人Co A近中期疗效满意,相关并发症少,远期效果需要进一步研究。Objective To evaluate the safety and efficacy of percutaneous balloon dilatation stent implantation in the treatment of congenital coarctation of the aorta (CoA) in adolescents and adults.Methods A retrospective analysis of 20 patients with congenital coarctation of the aorta from January 2010 to December 2017 in the cardiovascular surgery department of Xijing Hospital of the Air Force Military Medical University was implemented.There were 14 males and 6 females respectively,aged 27.68+13.45 years old. Two cases were combined with patent ductus arteriosus (PDA) and ventricular septal defect (VSD).The clinical data of patients during hospitalization and follow-up period were collected and analyzed.Results Percutaneous balloon dilatation stent implantation was successfully performed in 20 patients with CoA. The covered stents were implanted into patients,and the narrowest average diameter at the coarctation of the aorta was increased from 4.35±2.61 mm to 16.84±1.99 mm immediately after the operation,and the mean narrowing systolic pressure difference was decreased from 81.29±18.72 mmHg to 15.52±7.47 mmHg after the surgery.The mean systolic pressure of the right upper limb decreased from 182.05±38.99 mmHg to 141.95±32.11 mmHg postoperatively,and the mean systolic pressure of the lower extremity increased from 121.52±27.84 mmHg to 131.81±32.39 mmHg postoperatively.2 patients with PDA and VSD underwent simultaneous transcatheter closure without any shunt occured.During hospitalization and follow-up period,there were no obvious cardiovascular complications.Conclusion The effect of percutaneous balloon dilatation covered stent placement in the treatment of young and adult CoA is satisfactory with fewer complications,however further study is still needed for long-term effects.

关 键 词：主动脉缩窄 覆膜支架 介入治疗 

分 类 号：R541.1[医药卫生—心血管疾病]