经皮介入治疗儿童主动脉缩窄疗效观察(附22例报告)

Effect of percutaneous interventional treatment for coarctation of aorta in children:A report of 22 patients

目的评估儿童主动脉缩窄经皮介入治疗的安全性和有效性。方法回顾性分析2007年2月至2017年5月在广东省人民医院心儿科确诊并接受了经皮介入治疗的22例18岁以下主动脉缩窄患儿的病例资料。对一般临床资料、超声心动图、心脏增强CT、心导管检查、相关并发症、随访结果和预后进行分析。结果 22例患儿中男13例,女9例,年龄9个月至17岁(8.7±5.7岁),体重9.5~80.0 kg[(30.7±20.0)kg]。16例主动脉缩窄行经皮球囊成形术,6例主动脉缩窄行经皮覆膜支架置入。缩窄处收缩压峰值压力阶差由术前(52.7±25.0)mmHg降至(9.7±11.4)mm Hg(t=8.326,P=0.000,1 mm Hg=0.133 k Pa),缩窄处直径由术前(5.3±1.9)mm增加至(10.0±3.8)mm(t=-6.996,P=0.000)。2例术中出现局限主动脉夹层,随访3~6个月消失,无需干预;1例支架堵塞左侧锁骨下动脉需外科手术;无死亡病例。随访时间为3个月至9年,所有病例未行2次介入治疗或外科手术,支架未见变形及再狭窄。结论对于治疗儿童主动脉缩窄介入的经皮球囊成形术和支架置入术的近中期疗效可靠,安全性高。球囊成形术对于外科术后再狭窄的患儿也是一种安全的、可接受的选择。

Objective To evaluate the safety and curative effect of percutaneous interventional treatment for coarctation of aorta in children. Methods Retrospectively analyze the data of 22 children who were treated with percutaneous interventional treatment for coarctation of aorta from February 2007 to May 2017 in our institute.The general clinical data,echocardiography,cardiac CT,angiography,interventional results,the procedure-related complications and followup results were assessed. Results A total of 22 patients consisting of 13 boys and 9 girls underwent the procedure,with mean age of（8.7±5.7）years（ranging from 9 months to 17 years）and the mean body weight of（30.7±20）kg（ranging from 9.5 kg to 80.0 kg）. Totally 16 patients accepted balloon angioplasty and 6 patients accepted membrane-covered stent implantation. The catheter-measured narrowest aortic peak systolic gradient was successfully relieved in all the patients,decreasing from（52.7±25.0）mmHg to（9.7±11.4）mmHg immediately after percutaneous interventional treatment（t=8.326,P=0.000）. The diameter was increased from（5.3±1.9）mm to（10.0±3.8）mm immediately（t=-6.996,P=0.000）. During the procedure,two patients had limited aortic aneurysm,which disappeared after 3 to 6 months of followup without intervention. One needed surgery for left subclavian artery interrupted by stent;however,there were no deaths. The follow-up period was 3 months to 9 years. All patients hadn＇t accepted interventional therapy or surgery again,and the stents had no deformation or restenosis. Conclusion Percutaneous balloon angioplasty and stent implantation have reliable early and medium-term effect and high security for children＇s aortic coarctation. Percutaneous balloon angioplasty also is a safe and acceptable option for restenosis after surgery.