主动脉弓滑动成形术治疗婴幼儿主动脉缩窄并主动脉弓发育不良的临床研究

Clinical study of aortic arch sliding aortoplasty in surgical repair of infants with coarctation of the aorta and hypoplastic aortic arch

目的总结运用主动脉弓滑动成形术治疗婴幼儿主动脉缩窄合并主动脉弓发育不良的临床经验。方法回顾性分析2013年1月至2015年5月间采用主动脉弓滑动成形术治疗主动脉缩窄合并主动脉弓发育不良患儿8例的临床资料。患儿年龄（7．0±5．4）个月（2～21个月），体重（6．6±1．7）kg（4～10垤），男性6例，女性2例。均经胸骨正中切口在深低温体外循环和选择性脑灌注下，一期完成手术。根据患儿主动脉病理解剖的不同，主动脉弓滑动成形方法略有不同。以达到最好的解剖矫治效果。结果8例患儿均成功完成手术。全组无死亡，未出现肾功能障碍及神经系统功能并发症。术后定期随访（16．0±5．6）个月（6～20个月），末次随访患者下肢收缩压均高于上肢收缩压（8．9±3．2）mmHg（0～15mmHg）（1mmHg=0．133kPa），未发现再狭窄。结论主动脉弓滑动成形术治疗婴幼儿主动脉缩窄合并主动脉弓发育不良具有良好的近中期效果。

Objective To summarize the clinical experiences of aortic arch sliding aortoplasty in surgical repair of infants with coarctation of the aorta and hypoplastic aortic arch. Methods Eight patients with coarctation of the aorta and hypoplastic aortic arch who underwent surgical repair by aortic arch sliding aortoplasty from January 2013 to May 2015 were retrospectively analyzed. The patients＇ age was （7 ± 5.4） months （2-21 months） and weight was （6.6 ± 1.7） kg （4-10 kg）. Six of them were male and two of them were female. All the operations were performed through median sternotomy under deep hypothermia cardiopulmonary bypass with selective cerebral perfusion. According to the pathological anatomy of aortic arch, the techniques were different to reach optimal anatomical repair. Results All patients were repaired successfully. There was no mortality or major complication such as renal dysfunction or nervous system complications. Follow-up was carried out for （16.0 ± 5.6） months （6-20 months）. At the last follow-up, the lower limb systolic blood pressure was higher than upper limb systolic pressure in （8.9 ± 3.2） mmHg （0-15 mmHg）（1 mmHg= 0.133 kPa）. No patient showed evidence of residual obstruction. Conclusion Aortic arch sliding aortoplasty is an optimal surgical method to treat coarctation of the aorta with hypoplastic aortic, showing good short-and middle-term outcomes.