Background： Although balloon angioplasty （BA） has been performed for more than 20 years, its use as a treatment for native coarctation of the aorta （CoA） during childhood, especially in young infants, remains con...Background： Although balloon angioplasty （BA） has been performed for more than 20 years, its use as a treatment for native coarctation of the aorta （CoA） during childhood, especially in young infants, remains controversial. This study aimed to assess the effects and potential role ofpercutaneous transcatheter BA for native CoA as an alternative therapy to surgical repair in young infants. Methods： The 37 patients aged from 6 days to 6 months with severe CoA in congestive heart failure or circulatory shock were admitted for BA. Patient＇s weight ranged from 2.4 to 6.1 kg. All 37 patients were experiencing cardiac dysfunction, and eight patients were in cardiac shock with severe metabolic acidosis. Eleven patients had an isolated CoA, whereas the others had a CoA associated with other cardiac malformations. Cardiac catheterization and aortic angiography were performed under general anesthesia with intubation. Transfemoral arterial approaches were used for the BA. The size of the balloon ranged from 3 mm × 20 mm to 8 mm × 20 mm, and a coronary artery balloon catheter was preferred over a regular peripheral vascular balloon catheter. Results： The femoral artery was successfully punctured in all but one patient, with that patient undergoing a carotid artery puncture. The systolic peak pressure gradient （PG） across the coarctation was 41.0 ± 16.0 mmHg （range 13-76 mmHg）. The mean diameter of the narrowest coarctation site was 1.7 ± 0.6 mm （range 0.5-2.8 mm）. All patients had successful dilation; the PG significantly decreased to 13.0 ± 11.0 mmHg （range 0-40 mmHg）, and the diameter ofcoarctation significantly improved to 3.8 ± 0.9 mm （range 2.5-5.3 mm）. No intraoperative complications occurred for any patients. However, in one case that underwent a carotid artery puncture, a giant aneurysm formed at the puncture site and required surgical repair. The following observations were made during the follow-up period from 6-month to 7-year： （1） The PG across the coarctation measured by echocardiography further decreased or remained stable in 31 cases. The remaining six patients, whose PGs gradually increased, required a second dilation. No patient required further surgery because of a CoA; （2） in two cases, an aortic aneurysm was found with an angiogram performed immediately postdilatation and disappeared at 18 and 12 months of age, respectively; （3） tricuspid regurgitation and pulmonary hypertension improved in all patients; （4） all patients were doing well and were asymptomatic. Conclusions： Percutaneous BA is a relatively safe and effective treatment for severe native CoA in young infants, and should be considered a valid alternative to surgery because of its good outcome and less trauma and fewer complications than surgery.展开更多
There is considerable controversy over the mechanism of restenosis after percutaneous balloon angioplasty (PTCA). Vessel remodeling and plaque increase are among the possible contributors but angiography is methodolog...There is considerable controversy over the mechanism of restenosis after percutaneous balloon angioplasty (PTCA). Vessel remodeling and plaque increase are among the possible contributors but angiography is methodologically limited since it can not differentiate these different mechanisms. For evaluating the contribution of vessel and plaque changes after PTCA, we analyzed serial intravascular ultrasound (IVUS) studies in 59 lesions. IVUS study (3.5 F, 20 MHz catheter, Boston Scientific Co,; Hewlett Packard console) was performed immediately after PTCA (POST), and at follow up (FU, 6±1 months). At follow up, 40 lesions (Group Ⅰ) did not show restenosis and 19 (32.2%) lesions (Group Ⅱ) developed restenosis (area Department of Cardiology, University of Essen, Essen, Germany (Liu FQ, Ge JB, Baumgart D, Grge G, Haude M and Erbel R) stenosis >50%). Cross sectional vessel area (VA, mm 2), plaque area (PA, mm 2), and percent area stenosis (A%) were measured. [BHDFG1*2,WK3,WK5,WK11,WK11W]GROUP Ⅰ (±s)GROUP Ⅱ (±s) [BHDZ,WK3ZQ,WK5ZQ,WK11,WK11ZQ2W]VAPOST18.1±4.919.1±5.6FU17.7±4.618.9±6.2PAPOST9.9±3.212.0±4.7 *FU10.2±3.415.4±5.0 * A%POST55.6±7.568.4±6.3 *FU58.4±8.781.6±3.4 * * P <0.05, Group I vs Group II. In summary, plaque increase contributed significantly to late restenosis. This may be partly due to “recovery” of the plaque from redistribution (induced by balloon compression) and/or partly due to intimal proliferation. Greater residual plaque burden was also related to higher possibility of rstenosis.展开更多
文摘Background： Although balloon angioplasty （BA） has been performed for more than 20 years, its use as a treatment for native coarctation of the aorta （CoA） during childhood, especially in young infants, remains controversial. This study aimed to assess the effects and potential role ofpercutaneous transcatheter BA for native CoA as an alternative therapy to surgical repair in young infants. Methods： The 37 patients aged from 6 days to 6 months with severe CoA in congestive heart failure or circulatory shock were admitted for BA. Patient＇s weight ranged from 2.4 to 6.1 kg. All 37 patients were experiencing cardiac dysfunction, and eight patients were in cardiac shock with severe metabolic acidosis. Eleven patients had an isolated CoA, whereas the others had a CoA associated with other cardiac malformations. Cardiac catheterization and aortic angiography were performed under general anesthesia with intubation. Transfemoral arterial approaches were used for the BA. The size of the balloon ranged from 3 mm × 20 mm to 8 mm × 20 mm, and a coronary artery balloon catheter was preferred over a regular peripheral vascular balloon catheter. Results： The femoral artery was successfully punctured in all but one patient, with that patient undergoing a carotid artery puncture. The systolic peak pressure gradient （PG） across the coarctation was 41.0 ± 16.0 mmHg （range 13-76 mmHg）. The mean diameter of the narrowest coarctation site was 1.7 ± 0.6 mm （range 0.5-2.8 mm）. All patients had successful dilation; the PG significantly decreased to 13.0 ± 11.0 mmHg （range 0-40 mmHg）, and the diameter ofcoarctation significantly improved to 3.8 ± 0.9 mm （range 2.5-5.3 mm）. No intraoperative complications occurred for any patients. However, in one case that underwent a carotid artery puncture, a giant aneurysm formed at the puncture site and required surgical repair. The following observations were made during the follow-up period from 6-month to 7-year： （1） The PG across the coarctation measured by echocardiography further decreased or remained stable in 31 cases. The remaining six patients, whose PGs gradually increased, required a second dilation. No patient required further surgery because of a CoA; （2） in two cases, an aortic aneurysm was found with an angiogram performed immediately postdilatation and disappeared at 18 and 12 months of age, respectively; （3） tricuspid regurgitation and pulmonary hypertension improved in all patients; （4） all patients were doing well and were asymptomatic. Conclusions： Percutaneous BA is a relatively safe and effective treatment for severe native CoA in young infants, and should be considered a valid alternative to surgery because of its good outcome and less trauma and fewer complications than surgery.
文摘There is considerable controversy over the mechanism of restenosis after percutaneous balloon angioplasty (PTCA). Vessel remodeling and plaque increase are among the possible contributors but angiography is methodologically limited since it can not differentiate these different mechanisms. For evaluating the contribution of vessel and plaque changes after PTCA, we analyzed serial intravascular ultrasound (IVUS) studies in 59 lesions. IVUS study (3.5 F, 20 MHz catheter, Boston Scientific Co,; Hewlett Packard console) was performed immediately after PTCA (POST), and at follow up (FU, 6±1 months). At follow up, 40 lesions (Group Ⅰ) did not show restenosis and 19 (32.2%) lesions (Group Ⅱ) developed restenosis (area Department of Cardiology, University of Essen, Essen, Germany (Liu FQ, Ge JB, Baumgart D, Grge G, Haude M and Erbel R) stenosis >50%). Cross sectional vessel area (VA, mm 2), plaque area (PA, mm 2), and percent area stenosis (A%) were measured. [BHDFG1*2,WK3,WK5,WK11,WK11W]GROUP Ⅰ (±s)GROUP Ⅱ (±s) [BHDZ,WK3ZQ,WK5ZQ,WK11,WK11ZQ2W]VAPOST18.1±4.919.1±5.6FU17.7±4.618.9±6.2PAPOST9.9±3.212.0±4.7 *FU10.2±3.415.4±5.0 * A%POST55.6±7.568.4±6.3 *FU58.4±8.781.6±3.4 * * P <0.05, Group I vs Group II. In summary, plaque increase contributed significantly to late restenosis. This may be partly due to “recovery” of the plaque from redistribution (induced by balloon compression) and/or partly due to intimal proliferation. Greater residual plaque burden was also related to higher possibility of rstenosis.
