小于六个月婴幼儿主动脉缩窄离体球囊扩张效果研究

Effect of in vitro Balloon Dilatation for Treating Aortic Coarctation Infants Younger Than 6 Months

目的:观察、评价小于六个月婴幼儿主动脉缩窄离体球囊扩张的可行性。方法:本中心2011-01至2015-12期间,共有13例小于6个月龄主动脉缩窄婴幼儿,男9例,女性4例,年龄20天~6个月(平均3.4个月),体重3.6~6.2 kg(平均4.8 kg)。术中切除主动脉狭窄段,对其采用狭窄段直径2~4倍经皮血管成形术(PTA)外周球囊扩张,计算狭窄段扩张前后直径变化,并进行苏木精-伊红(HE)染色,观察中层平滑肌变化。结果:其中8例合并非限制性室间隔缺损(其中3例行分期手术),2例房间隔缺损,3例主动脉瓣二瓣式,3例动脉导管未闭,1例心包积液。手术过程中留取13例主动脉缩窄患儿的主动脉狭窄段,其中9例为隔膜型,4例为管型狭窄。行球囊扩张后,其直径略有增长,平均增长0.2 mm,未见明显变化,采用HE染色示其内层粘膜脱落,但中层平滑肌连续性完整。结论:球囊扩张治疗小于6个月龄婴幼儿主动脉缩窄效果差,建议采用外科手术治疗此类患儿。

Objective： To evaluate the feasibility ofin vitro balloon dilatation for treating aortic coarctation infants younger than 6 months. Methods： A total of 13 aortic coarctation infants treated in our hospital from 2011-01 to 2015-12 were summarized. The patients were at the mean age of 3.4 months （from 20 days to 6 months）, with the mean body weight of 4.8 kg （from 3.6 kg to 6.2 kg） including 9 male. Aortic coarctation segments were resected during the operation and the resected segments were expanded by percutaneous transluminal angioplasty （PTA） via （2-4） times diameter balloon dilatation. The diameters of resected aortic segments were recorded before and after expansion; the change of vascular middle smooth muscle layer was observed by HE staining. Results： There were 8 cases with non-restricted ventricular septal defect （VSD） and 3 of them received staging operation, 2 with atrial septal defect （ASD）, 3 with bicuspid aortic valve, 3 with patent ductus arteriosus （PDA） and 1 with pericardial effusion. The resected aortic segments presented that 9 patients had diaphragm type narrow and 4 had tube type narrow. After PTA, the diameters of resected aortic segments were slightly increased for the mean of 0.2 mm and no obvious change was observed; HE staining showed that the vascular inner mucosa was shed, while the middle smooth muscle layer was intact. Conclusion： Balloon dilatation had the poor effect for treating aortic coarctation infants younger than 6 months; surgical procedure could be applied for treating the relevant patients.