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球囊扩张成形术治疗儿童主动脉缩窄一年随访

Balloon angioplasty for native coarctation in children: one year follow-up results

摘要:

目的 评价球囊扩张成形术治疗不同年龄儿童先天性主动脉缩窄的效果与安全性.方法 回顾性分析2006年1月至2012年12月收治的37例未经治疗的局限性主动脉缩窄患儿在复旦大学附属儿科医院实施球囊扩张成形术的临床资料.37例患儿中男26例、女11例;中位年龄10个月(7d~6岁);体重6.3 (2.5~17.0) kg.术后随访1年,包括穿刺部位的动脉搏动、缩窄部位的再狭窄以及动脉瘤的形成,并对手术时年龄≤3个月和>3个月的患儿进行比较.组间比较采用t检验或Fisher精确检验.结果 球囊扩张成形术在37例患儿中均获得了成功,术后即刻测量,缩窄两端收缩期峰值压差降至<20 mmHg(1 mmHg =0.133 kPa).手术时年龄≤3个月组25例与>3个月组12例患儿术前的主动脉缩窄两端收缩期峰值压差差异无统计学意义[收缩期最大压差(51±21)比(61±16) mmHg,收缩期平均压差(31±11)比(40±13) mmHg,均P>0.05];术后跨缩窄前后的压差分别由术前(38±18)和(47±18) mmHg降至(12±11)和(17±12)mmHg(均P<0.01),缩窄段直径由(1.8±0.7)和(2.6±1.5)mm增至(3.7±1.1)和(5.5±1.8)mm(均P<0.01).32例(86.5%)患儿完成了术后为期1年的随访,其中3例(9.4%)出现术后穿刺部位动脉损伤,均发生在≤3个月组(P =0.537);8例(25.0%)术后发生主动脉缩窄部位再狭窄,其中≤3个月组6例,>3个月组2例,两组之间再狭窄发生率差异无统计学意义(P=1.000).2例(5.4%)患儿术后即刻在扩张部位出现小型动脉瘤,其中≤3个月组和>3个月组各1例(12/25比1/12,P=0.755).17例患儿在术后1年进行了计算机断层摄影血管造影或磁共振血管造影检查,未发现远期新的动脉瘤形成.结论 对于儿童局限性主动脉缩窄,球囊扩张成形术近期疗效佳,安全性高,其中手术时年龄≤3个月与>3个月组患儿的术后穿刺动脉损伤、缩窄部位的再狭窄以及动脉瘤的形成的发生率无差异.

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abstracts:

Objective Balloon angioplasty is an alternative to surgical repair for coarctation of the aorta in children.However,its role in the treatment of neonates and infants younger than 3 months old remains controversial.The purpose of this study was to evaluate the efficacy and safety of balloon angioplasty for native coarctation by comparing children in different age groups.Method This is a retrospective clinical study including 37 children treated with balloon angioplasty for native coarctation from January 2006 to December 2012.A total of 37 patients consisting of 26 boys and 11 girls underwent the procedure,with median age 10 months (range from 7 days to 6 years) and the mean body weight was 6.3 (2.5-17.0) kg.The indication of the procedure includes discrete native coarctation without aortic arch hypoplasia and a peak-to-peak systolic pressure gradient > 20 mmHg (1 mmHg =0.133 kPa) across aortic coarctation.During one year follow-up,the approach artery injury,recoarctation and aneurysm formation were particularly assessed.Result We classified these patients into two groups according to their age.Group A consisted of 25 patients younger than 3 months and Group B of 12 patients older than 3 months.There was no significant difference between the two groups in systolic pressure gradient before balloon angioplasty (P > 0.05).The mean peak systolic gradient decreased from (38 ± 18) mmHg to (12 ± 11) mmHg immediately after angioplasty in group A and from (47 ±18) to (17 ± 12) mmHg in group B (P =0.000 for both).Meanwhile,the mean diameter of the coarctation segment increased from (1.8 ± 0.7) to (3.7 ± 1.1) mm after angioplasty in group A and from (2.6 ± 1.5) to (5.5 ± 1.8) mm in group B (both P =0).The initial successful balloon angioplasty (immediate postangioplasty peak pressure gradient < 20 mmHg) was achieved in all the 37 patients; 32 patients (86.5%) have been followed up for one year.Approach arterial complications occurred in 3 patients (9.4%),all of whom were in Group A (P =0.537).Two patients had decreased femoral artery pulse and one required surgical repair for a postoperative pseudoaneurysm at left carotid artery.At follow-up,8 patients (25.0%) developed recoarctation,with 6 cases in Group A and 2 in Group B.There was no significant difference between groups A and B in the recoarctation rate (P =1.000).Among them,7 patients underwent repeat balloon angioplasty,and all showed successful relief of coarctation,and one patient required surgical repair.Two patients (2/37,5.4%) had small aneurysms of the descending aorta immediately after balloon angioplasty,with one patient in each group (12/25 vs.1/12,P =0.755).Late aneurysm development has not been observed in the 17 patients who have had a follow-up CTA or MRA study.Conclusion Balloon angioplasty of discrete native coarctation is effective and safe in children both younger and older than 3 months with similar incidence of approach arterial complication,recoarctation and aneurysm formation.

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