应用NuMED CP覆膜支架治疗先天性主动脉缩窄

目前先天性主动脉缩窄的介入治疗主要采用球囊扩张及血管内支架置入方法，但对于严重主动脉缩窄难度较大。我们应用美国NuMED公司Cheatham-Platinum（CP）覆膜支架成功为一名合并动脉导管未闭的严重主动脉缩窄的患者实施了介入治疗。     

主动脉缩窄患者支架置入治疗后发生断裂1例

主动脉缩窄是一种罕见疾病,介入支架术是其近些年的主流治疗手段,术后即刻疗效显著,但我国对该类患者长期随访的报道较少。本文报告1例主动脉缩窄的年轻女性,在支架置入11年后门诊复查时发现主动脉支架断裂,提示了该类患者长期影像学随访的必要性。     

主动脉覆膜血管内支架治疗DebakeyⅢ型主动脉夹层的临床疗效

目的 总结主动脉覆膜血管内支架治疗DebakeyⅢ型主动脉夹层的临床疗效.方法 选取本院2009年8月至2014年7月经CT增强扫描确诊为DebakeyⅢ型主动脉夹层的患者63例,从股动脉植入主动脉覆膜血管内支架,封堵破口.植入后重复进行血管造影检查.结果 血管内支架植入全部成功.术后造影60例无内漏,3例轻度内漏,1例出现左上肢缺血.随访CT检查1～3年,未出现脊髓损伤、支架移位等并发症,大部分胸背痛等症状消失.结论 主动脉覆膜血管内支架是治疗胸主动脉瘤的有效方法,近期疗效满意.     

覆膜血管内支架置入治疗B型主动脉夹层的临床应用研究

目的:评价覆膜血管内支架置入治疗B型主动脉夹层的疗效。方法:180例B型主动脉夹层,男158例,女22例,年龄(50．4±10．9)岁。术前行计算机体层摄影术(CT)增强扫描检查。在数字减影血管造影(DSA)监测下选用覆膜血管内支架封堵夹层原发破口。置入后即刻重复DSA检查。随访行胸部X线平片与CT增强扫描检查。结果:技术成功率99．4％(179／180),1例支架位置过高,行外科升主动脉-左颈总动脉-左锁骨下动脉搭桥术。术后即刻造影160例无内漏,18例少量内漏,2例中量内漏近段加短袖套支架(Cuff)后内漏消失;降主动脉真腔明显扩大,腹主动脉及分支供血均有不同程度的改善。术后随访(18．6±7．2)个月,18例少量内漏12例6个月内消失、6例无加重;21例支架段假腔消失,余者近端假腔内均有血栓形成;1例支架远端形成假性动脉瘤破裂死亡。结论:覆膜血管内支架置入治疗B型主动脉夹层安全有效,近、中期疗效满意,远期疗效有待于进一步观察。     

经皮支架置入术治疗主动脉缩窄的疗效及安全性

目的　评估经皮支架置入术治疗主动脉缩窄的疗效。方法　 5例 [男性 3例 ,平均年龄(33± 9)岁 ]胸主动脉缩窄患者行经皮主动脉球囊成形术及支架置入术。结果　各例支架置入后即刻压力阶差显著减低为 (8± 2 )mmHg(1mmHg =0 133kPa) ,与术前 (73± 6 )mmHg比较 ,差异有显著性(P <0 0 0 1)。平均随访 (2 7± 12 )月 ,各例无需多种药物治疗但血压控制良好 ,收缩压平均为 (15 2± 7)mmHg ,舒张压 (91± 5 )mmHg ,与术前收缩压 (2 0 1± 8)mmHg、舒张压 (12 0± 8)mmHg比较 ,差异有显著性 (P <0 0 0 1) ,无不良事件发生。结论　经皮支架置入术治疗主动脉缩窄安全可行 ,且对患者血压控制具有长期疗效。     

覆膜血管支架治疗外伤性主动脉破裂

目的:总结利用覆膜血管支架治疗主动脉外伤的经验和体会。方法:2008年5月至2011年2月,完成覆膜血管支架,治疗外伤后主动脉破裂16例,其中男性12例,女性4例;年龄22～77岁,平均(43.2±23.5)岁,体质量43～92 kg,平均(71±16)kg;10例为Stanford B型主动脉夹层动脉瘤,6例为降主动脉假性动脉瘤形成。结果:全组无围术期死亡,无脊髓损伤、肢体缺血、支架移位及急性脑缺血等严重并发症。术后住院7～25 d,术后3个月,复查胸主动脉CT血管造影(CTA)示原发破口封闭满意,支架位置良好。结论:覆膜血管支架置入术,是治疗外伤性主动脉破裂的可靠方法,若适应证明确,可替代传统开胸手术治疗。     

Cheatham-Platinum支架置入治疗儿童主动脉缩窄的疗效评价

目的:评价Cheatham-Platinum(CP)支架治疗儿童主动脉缩窄的早中期疗效。方法:对14例主动脉缩窄(coarctation of the aorta,CoA)儿童行CP支架置入术,其中男性8例,女性6例;年龄4~14岁(中位年龄11岁);体质量19.9~60kg(中位体质量38.2kg)。6例(43%)为未经治疗CoA;8例(57%)为再狭窄CoA。收集和分析CP支架置入前后的数据和随访资料。结果:14例患儿均成功置入CP支架,其中6例裸支架,8例覆膜支架。术后即刻CoA最窄处直径由(6.45±1.39)mm增加至(11.79±1.59)mm,P0.001;CoA/Dao比由0.41±0.12增加至0.74±0.10,P0.001;导管测得跨狭窄压差由[(34.86±17.48)mmHg(1mmHg=0.133kPa),下降至(1.64±1.64)mmHg,P0.001];心脏超声测得跨狭窄压差由[(59.76±15.92)mmHg,下降至(23.89±7.30)mmHg,P0.001];上肢收缩压由[(142.07±28.95)mmHg降为(124.79±25.92)mmHg,P0.001];下肢收缩压由[(105.21±21.35)mmHg升为(122.29±25.29)mmHg,P0.05]。未见主动脉瘤和主动脉夹层的发生。1例患儿术中发生髂动脉内膜撕脱导致术后死亡。随访结果未见再狭窄,未见支架的移位断裂。结论:CP支架治疗儿童CoA早中期疗效好,但远期效果尚需进一步的随访和更多病例的研究。     

食管超声引导覆膜支架介入治疗胸主动脉夹层

目的　评价应用食管超声经股动脉植入覆膜支架治疗DeBakeyⅢb型主动脉夹层动脉瘤的安全性和效果。方法　 8例男性患者均经磁共振血管造影 (MRA)证实为DeBakeyⅢb型主动脉夹层。平均年龄 55 8± 10 2 (2 8～ 71)岁。在食管超声引导和透视监测下 ,经股动脉切开植入覆膜支架封闭近端或近、远端主动脉夹层破口。并评价术后即刻和随访结果。结果　 8例患者共成功植入覆膜支架 11枚 ,支架平均直径为 2 9 4(2 2～ 3 8)mm。术后即刻 3例有极少量内漏 ,2例有微量烟雾状分流。 1例在球囊扩张后升主动脉出现局限夹层。术后平均住院时间为 9d。随访 8例 ,平均随访时间 10 5(6～ 18)个月 ,4例残余分流消失 ,无发生支架移位或新生内漏者。升主动脉局限夹层患者于术后 11个月行MRA复查示病情稳定未再发展。 1例于术后 1年复查MRA仍有极少量内漏 ,后因咯血突发死亡。结论　联合应用食管超声 ,经股动脉植入覆膜支架治疗DeBakeyⅢb型主动脉夹层是一项有前景的方法 ,而且创伤小、安全有效 ,近中期效果满意 ,远期结果需进一步观察     

覆膜支架治疗胸降主动脉夹层

目的探讨覆膜支架治疗胸降主动脉夹层的方法和疗效。方法对11例胸降主动脉夹层患者行覆膜支架治疗。术前强化CT检查明确诊断，根据病变血管近侧正常血管直径加上其直径的15％～20％选择支架型号。术中先行主动脉造影，确定内膜破口位置，分辨真假腔，选择恰当的手术入路及合适的支架。腹股沟处切开，游离出股动脉并切开，插入支架输送器，降血压，于破口位置缓慢释放覆膜支架，封闭主动脉内膜破口。重新造影，观察支架的位置，检查是否有内漏。结果11例均成功植入支架，患者疼痛症状消失，升主动脉造影示真腔扩大，9例假腔血流消失，2例有内漏。所有病例随访3～30个月，无死亡。术后1、3、6个月和满1年分别行强化CT检查。2例内漏患者中，1例3个月后自行封闭，1例因破口大，靠近左锁骨下动脉口，术后3个月仍有内漏。2例肾动脉受影响者血流明显改善。5例胸膜后血肿患者术后3个月完全吸收。无截瘫、左上肢缺血等并发症。结论覆膜支架治疗胸降主动脉夹层创伤小，操作简单，手术死亡率低，并发症少，近期效果良好。     

CP支架和双球囊导管在儿科先天性心脏病血管狭窄中的应用

Cheatham-Platinum（CP）支架专门用于治疗与先天性心脏病相关的血管梗阻，在设计上充分考虑了儿童躯体生长将来支架再扩张问题；双球囊导管则有助于支架的精确定位。CP支架治疗儿科先天性心脏病血管狭窄安全可行，初步结果令人鼓舞。     

Long-term follow-up study of elderly patients with covered stent implantation after coronary perforation

ObjectiveTo evaluate the long-term efficacy of covered stent implantation in the treatment of elderly patients with coronary perforation while undergoing percutaneous coronary intervention （PCI）.MethodsFrom June 2004 to June 2012, our center has followed ten elderly patients （age≥ 60 years） who sustained coronary perforation during PCI. The major adverse cardiac events （MACE） were observed as well. The patients were advised to take 75 mg/day Clopidogrel for two years, and indefinite use of 100 mg/day enteric-coated aspirin.ResultsSix out of the 10 patients aged from 60 to 76 years old （mean 68.6 ± 5.2 years） were male, four were female. The average diameter of the implanted stents was 3.3 ± 0.3 mm, and the average length was 22.1 ± 3.7 mm. All the ruptures were successfully sealed without intra-procedural death. The follow-up duration ranged from 0.6 to 67 months （mean 31.7 ± 24.5 months）. One patient died of multiple organ failure due to lung infection in 19 days after PCI; one died of cardiac sudden death in 13 months after PCI; one had angina pectoris in 53 months after PCI; one underwent multi-slice CT examination in six months after PCI, and no in-stent restenosis was found. The other four patients received angiography follow-up, and the results showed that three patients had no intra-stent restenosis, while one had left anterior descending （LAD） restenosis in the covered stent in 67 months after PCI. The in-hospital mortality was 10% （1/10）. The MACE rate in 12 months after PCI was 10% （1/10）. During the entire followed-up period, the restenosis rate in target vessels was 20% （1/5）, mortality was 20% （2/10）, and the MACE rate was 40% （4/10）.ConclusionTreatment of coronary perforation by using covered stents can achieve favorable long-term results; a two-year dual antiplatelet therapy （DAPT） after PCI can effectively prevent intra-stent thrombosis.     

Collapse of the advanta V12 large diameter covered stent following implantation for aortic coarctation

We report a case of collapse of the Advanta V12 Large Diameter (LD) covered stent following previous successful implantation for native aortic coarctation. This unreported complication was successfully managed with subsequent stent redilation and implantation of two covered Cheatham‐Platinum stents within the collapsed Advanta V12 stent. This case highlights the importance of correct stent apposition to the aortic wall and also raises some concerns regarding the radial strength of the Advanta V12 stent. © 2013 Wiley Periodicals, Inc.     

Endovascular repair of severe aortic coarctation,transcatheter aortic valve replacement for severe aortic stenosis,and percutaneous coronary intervention in an elderly patient with long term follow-up

To the best of our knowledge, there have not been any reports of total transcatheter approach including stenting of severe coarctation of the aorta (CoA), transcatheter aortic valve replacement (TAVR) for concomitant severe aortic valve stenosis, and percutaneous coronary intervention (PCI) to treat significant coronary artery disease in a single patient. We report a 70-year-old female, who presented with uncontrolled hypertension and acute decompensated heart failure (ADHF) and was found to have severe CoA, severe bicuspid aortic valve (BAV) stenosis, and significant proximal left anterior descending (LAD) coronary artery disease. In a multidisciplinary heart team meeting, we decided to perform an endovascular repair of both cardiac and vascular pathologies using a two-stage approach due to the significant comorbidities; mainly uncontrolled hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and severe calcifications of the ascending aorta. The procedures were successfully performed and the patient was asymptomatic 30?months later at follow-up and was without any significant gradients across the coarctation or the aortic valve.     

重症主动脉缩窄的外科治疗

对合并心内畸形、动脉导管来闭和肺动脉高压的重症主动脉缩窄（CA）患儿3例行体外循环下手术矫治。结果：2例顺利完成手术，1例于术后2h突发急性肺水肿死亡。结论：对该类患儿，除年龄过小、心力衰竭难以控制或技术条件限制外，均宜采用体外循环下一次性同期矫治CA及心内畸形。术中降主动脉插管行下半身灌注，可避免因股动脉插管可能引起的灌注量受限、下肢供血不足、术后缺血性改变及术后插管处狭窄。     

Management of adults with coarctation of aorta

Coarctation of the aorta (CoA) is a relatively common congenital cardiac defect often causing few symptoms and therefore can be challenging to diagnose. The hallmark finding on physical examination is upper extremity hypertension, and for this reason, CoA should be considered in any young hypertensive patient, justifying measurement of lower extremity blood pressure at least once in these individuals. The presence of a significant pressure gradient between the arms and legs is highly suggestive of the diagnosis. Early diagnosis and treatment are important as long-term data consistently demonstrate that patients with CoA have a reduced life expectancy and increased risk of cardiovascular complications. Surgical repair has traditionally been the mainstay of therapy for correction, although advances in endovascular technology with covered stents or stent grafts permit nonsurgical approaches for the management of older children and adults with native CoA and complications. Persistent hypertension and vascular dysfunction can lead to an increased risk of coronary disease, which, remains the greatest cause of long-term mortality. Thus, blood pressure control and periodic reassessment with transthoracic echocardiography and three-dimensional imaging (computed tomography or cardiac magnetic resonance) for should be performed regularly as cardiovascular complications may occur decades after the intervention.     

Repair of coarctation of aorta with preservation of blood supply to upper limb

In this report, we present a modified technique of extended resection and end-to-end anastomosis of aorta for repair of coarctation of aorta. The advantages of this technique are a larger tension free anastomosis without compromising the blood supply into the left subclavian artery.