介入治疗主动脉缩窄14例临床分析

Percutaneous intervention on congenital coarctation of the aorta

目的探讨球囊成形术和支架植入术治疗主动脉缩窄的有效性和安全性。方法自2005年4月至2010年2月,共对14例患者(男性8例)实施主动脉缩窄球囊成形术和支架植入术,年龄(17±9)岁。根据患者年龄和主动脉缩窄解剖形态选择介入治疗方式。结果单纯主动脉缩窄9例,合并动脉导管未闭5例;膜状主动脉缩窄12例,管状缩窄2例。所有患者均成功实施介入治疗。年龄小于14岁者4例,跨缩窄段压力阶差为(45±9)mmHg,球囊成形术后2例压力阶差消失,2例存在10mmHg以内压力阶差。主动脉缩窄支架植入术10例,跨缩窄段压力阶差为(51±18)mmHg。8例植入覆膜支架,2例植入非覆膜支架。5例合并动脉导管未闭患者中,4例行覆膜支架植入术,1例同时行动脉导管未闭封堵术和非覆膜支架植入术。术后2例患者存在少量压力阶差。所有患者无重大并发症,随访(31±21)个月,未见再狭窄发生。结论介入方式治疗主动脉缩窄安全、可靠,可以取代外科手术成为首选治疗方式。具体采用何种介入治疗方式,需要根据患者年龄和缩窄段解剖形态确定。

Objective To investigate the feasibility and safety of balloon angioplasty and stenting for coarctation of the aorta （CoA）. Methods Between April 2005 and February 2010,14 patients （8 males） aged 17±9 years with CoA underwent balloon angioplasty or stent implantation according to the age and the anatomy of the coarctation. The outcome and follow-up results were analyzed. Results There were isolated CoA in 9 patients and CoA complicated with patent ductus arteriosus （PDA） in 5 patients. The CoA was membraneous in 12 patients and tubular in 2 patients. The primary procedure was successful in all the patients. The trans-coarctation pressure gradient （TCPG） was 45±9 mmHg in 4 children aged less than 14 years before balloon dilation. After balloon angioplasty,TCPG disappeared in 2 patients and became less than 10 mmHg in 2 patients,respectively. Ten patients underwent stent implantation. The TCPG was 51±18 mmHg before stenting. The devices used were covered stents in 8 patients and uncovered stents in 2 patients. In 5 patents with CoA and PDA,4 underwent stenting by using covered stents and one underwent stenting by using an uncovered stent and PDA closure by using a ductal occluder simultaneously. TCPG disappeared in all but two patients. No major complications occurred during the procedure. The patients were followed-up for 31±21 months and all were alive with no restenosis. Conclusion Percutaneous intervention on CoA is feasible and safe and might be a promising alternative to the surgery,but requires different techniques according to the anatomy of coarctation and the age of the patients.