升主动脉-腹主动脉搭桥术治疗成人复杂主动脉缩窄

目的：探讨成人复杂主动脉缩窄安全有效的手术方法。方法：全麻常温下经胸腹正中联合切口行升主动脉—腹主动脉搭桥术。结果：５例患者术后上肢血压下降明显,下肢血压升高满意,无神经系统和其它严重并发症。结论：该手术显露和操作简单、适应证广、疗效确切、并发症少和费用低。     

一期升主动脉-降主动脉转流治疗主动脉缩窄合并心脏畸形

目的:主动脉缩窄合并其他心脏病手术的方法仍然存在争议。本研究的目的是评估经胸骨正中切口一期升主动脉-降主动脉转流+心脏畸形矫治术治疗主动脉缩窄合并其他心脏畸形的疗效。方法:选择我院于2009年4月至2017年6月,应用经胸部正中切口行升主动脉-降主动脉心包内转流术,同期行合并心脏畸形矫治手术的患者13例,女性3例,男性10例,平均年龄35岁(19～59岁)。其中3例bentall术,8例主动脉瓣置换,1例二尖瓣置换,1例二尖瓣成形术。结果:随访期间无死亡病例,主动脉阻断时间和体外循环时间分别是(81±33) min、(123±47) min。术后上肢血压明显改善(P0.001),有术前的(159±34) mmHg(1 mmHg=0.133 kPa)将至术后(122±17) mmHg,截止最后一次随访,患者上下肢血压无明显压差。结论:一期升主动脉-降主动脉转流治疗主动脉缩窄合并心脏畸形远期效果显著,可以作为主动脉缩窄合并其他心脏畸形的患者选择此手术方式。     

大鼠升主动脉缩窄术及其意义

心力衰竭是极为常见的严重的临床综合征 ,是各种心血管病的终末期共同的归路。临床上很多心血管疾病都经历了心肌肥厚到心力衰竭的病理生理演变过程 ,然而代偿良好的心肌是如何发生失代偿的 ,其机制尚不清楚。我们用自制的工具和技巧缩窄幼鼠升主动脉 ,观察术后不同时间大鼠的临床表现及心功能状况 ,在 5个月内建立了由心肌肥厚到心力衰竭的模型。1　材料与方法Ｗｉｓｔａｒ大鼠 ,雌性 ,生后 3～ 4周 ,5 0只。大鼠称重后 ,用戊巴比妥钠 40ｍｇ/ｋｇ腹腔麻醉 ,气管插管 ,接小动物呼吸机 ,潮气量 3ｍｌ,呼吸频率 10 0次 /ｍｉｎ。无菌条件下 ,…     

54例主动脉缩窄的外科治疗

我院 1984年 6月至 1998年 6月 ,共收治 54例主动脉缩窄病人。男性 2 7例 ,女性 2 7例 ,平均年龄 15.8岁 ( 5个月～ 39岁 )。其中婴儿型 18例 ,成人型 36例 ,合并动脉导管未闭 33例 ,室间隔缺损 2 0例 ,房间隔缺损 4例 ,主动脉瓣二瓣化畸形 4例 ,主动脉瓣下狭窄 3例 ,二尖瓣狭窄 2例 ,二尖瓣脱垂 1例。其中 39例进行狭窄处补片扩大成形术 ,5例进行狭窄处切除主动脉端端吻合术 ,3例进行了狭窄处切除人工血管移植术 ,4例进行了人工血管转流手术 ,3例用主肺动脉内隧道的方法 ,实现了升主动脉 降主动脉的连接 ,同时行室缺修补。手术死亡 1例 ( 1.85% )。远期随访死亡 3例 ( 5.6% ) ,其余效果良好     

婴幼儿主动脉缩窄外科治疗进展

主动脉缩窄是一种较为常见先天性心脏病,婴幼儿期的主动脉缩窄常伴有复杂畸形,未经治疗死亡率较高.本文主要介绍主动脉缩窄外科手术的选择;伴主动脉弓发育不良的处理方法和时机选择;合并室间隔缺损的主动脉缩窄的外科处理;再缩窄的处理.     

婴幼儿主动脉缩窄外科治疗进展

主动脉缩窄是一种较为常见先天性心脏病,婴幼儿期的主动脉缩窄常伴有复杂畸形,未经治疗死亡率较高。本文主要介绍主动脉缩窄外科手术的选择;伴主动脉弓发育不良的处理方法和时机选择;合并室间隔缺损的主动脉缩窄的外科处理;再缩窄的处理。     

先天性主动脉缩窄行人工血管旁路移植术1例

患者,女,26岁.因发现患高血压1月后入院,既往有双下肢乏力病史10年余,无心慌、胸闷、头晕等不适,一直未测血压.1月前因感冒测BP 180/90mmHg.入院检查:T 36.3℃,R 20次/min,P 77次/min,BP右上肢216/96 mmHg、左上肢190/90mmHg、双下肢收缩压60 mmHg,神志清楚,发育正常,皮肤黏膜无黄染,口唇无紫绀,浅表淋巴结无肿大,甲状腺无肿大.     

介入治疗降主动脉缩窄致高血压1例

正继发性高血压(secondary hypertension)在高血压人群中占5%~10%,随着诊断技术的不断提高这个比例逐渐上升。主动脉缩窄(coarctation of aorta,Co A)是继发性高血压发病原因之一,指先天性胸主动脉局限性狭窄甚至闭塞,缩窄远近端形成侧支循环是其明显特征。我科近期成功诊治降主动脉缩窄致高血压患者一例。病历资料:患者男性,21岁,因"体检发现血压升高1年"入院,入院前1年体检发现血压升高,血压达200/110mm Hg(1mm Hg=0.133k Pa),偶有头晕症状,患者未予重视,近2个月来血压均较高,最高达240/140mm Hg,为求进一     

婴幼儿主动脉缩窄合并心内复杂畸形的一期手术治疗

目的:探讨婴幼儿主动脉缩窄合并心内复杂畸形一期手术的治疗方法及手术效果.方法:回顾分析2002-11至2008-09收治的婴幼儿主动脉缩窄合并心内复杂畸形一期手术治疗的临床病例.共计18例,其中男12例,女6例.年龄平均(7.7±8.8)个月,体重(6.1±2.4)kg.主动脉缩窄包括合并主动脉弓发育不良5例,单纯主动脉缩窄13例.不合并主动脉弓发育不良者,切除缩窄段,端端吻合降主动脉;合并主动脉弓发育不良者,切除缩窄段,用自体心包或自体肺动脉片加宽主动脉弓.心内复杂畸形的矫治包括完全性大动脉转位大动脉调转术8例,右心室双出口根治术6例,右心室双出口陶西平畸形大动脉调转术3例,完全性心内膜垫缺损矫治术1例.结果:所有患儿出院前超声心动图检查均显示主动脉弓降部缩窄解除,吻合口通畅,血流正常.无中枢神经系统并发症.术后早期上、下肢收缩压基本相等者4例,上肢高于下肢15～20mmHg者8例,上肢低于下肢收缩压5～10mmHg者6例.死亡3例,死亡率16.7%.1例术后当天死于低心排综合征,1例术后9天死于肺部感染,1例术后7天死于突发恶性心律失常.术后另3例出现右侧膈肌麻痹行膈肌折叠术.结论:婴幼儿主动脉缩窄合并心内复杂畸形经胸骨正中切口一期手术治疗,主动脉弓及降主动脉上段显露良好.同期矫治心内复杂畸形手术效果满意.深低温停循环区域性脑灌注可有效降低神经系统并发症的发生.     

单纯主动脉缩窄的外科治疗

目的总结单纯主动脉缩窄外科治疗的经验,评价手术时机和方法。方法1990年6月至2005年8月,手术治疗单纯主动脉缩窄17例,其中行主动脉缩窄切除对端吻合术5例,人工血管移植术3例,补片成形术7例,Vosschulte成形术1例,左锁骨下动脉-降主动脉人工血管转流术1例。结果术毕上下肢平均动脉压的压差<10mmHg者13例,上肢平均动脉压仍高于下肢10～30mmHg者4例。术后早期高血压者14例。随访5个月至10年,下肢血压高于上肢者13例,无明显差异者3例,下肢血压仍明显低于上肢者1例,仍有高血压者5例;成形部位动脉瘤样扩张1例,再缩窄1例。结论早期诊断、早期治疗是提高生存率和减少术后高血压的关键。手术方法应根据患者年龄、病理特征和术者经验选择。     

Extra-anatomic aortic bypass for treatment of atypical aortic coarctation

Background The conventional extra-anatomic bypass is originated from the axillary’s artery and the graft size is often limited due to the small diameter of axillary’s artery. Extra-anatomic bypass graft originating from ascending aorta can improve the graft size and distal perfusion, but need sternotomy which might have higher operative risks compared with axillo-femeral bypass. We summarize our experiences of extra-anatomic bypass from ascending aorta for atypical aortic coarctation. Methods Between January 2005 and February 2008, 5 women aged from 18 to 64 years underwent extra-anatomic bypass from ascending aorta to abdominal aorta or iliac artery bypass for treatment of atypical aortic coarctation. Preoperatively, all patients had hypertension and needed anti-hypertensive medications. Systolic blood pressure was 151 ± 9 mmHg. Ankle pressure index (API) were 0.60 ± 0.23 in left and 0.56 ± 0.23 in right. Average systolic pressure gradient of aortic stenosis was 76 ± 18 mmHg. Three patients underwent concomitant cardiac operation, including coronary artery bypass grafting, Bentall procedure and atrial septal defect repair. Results There was no hospital and late mortality during 58 ± 15 months follow-up (range from 44 to 81 months). Postoperative systolic blood pressure was reduced to 126 ± 11 mmHg at the time of discharge. All patients maintained normal blood pressure without medication during follow-up. API was improved to 1.12 ± 0.24 in left and 1.17 ± 0.25 in right (compared with preoperative data, P < 0.05). Follow-up computer tomography showed patency in all grafts. Conclusions Surgical treatment of atypical aortic coarctation with extra-anatomic bypass originating from ascending aorta alleviates hypertension and low limb ischemia.     

成人型主动脉缩窄的外科治疗

目的:总结成人型主动脉缩窄的外科治疗经验。方法:自2007年2月至2007年6月,我们采用胸-腹主动脉转流治疗5例成人型主动脉弓缩窄。结果:本组患者无手术死亡及严重并发症。术后上肢血压明显下降,上下肢血压差由术前平均72 mmHg(1 mmHg=0.133 kPa)降至-4 mmHg。未见人工血管并发症。结论:成人型主动脉缩窄手术治疗效果满意;手术方式的选择应根据病变的具体情况和术者经验而定;胸-腹主动脉转流术是一种安全有效的治疗方式。     

Combined angioplasty and valvuloplasty for coexisting coarctation of the aorta and aortic stenosis in an infant

The patient was a 1-month-old male infant. Echocardiography showed left ventricular hypertrophy with coarctation of the aorta (CoA) and aortic valve stenosis (AVS). Left ventricular systolic function was poor. At catheterization, the gradient of AVS was 25 mmHg and the annulus size of the aortic valve was 7 mm. There was a CoA measuring 2.1 mm in diameter. Balloon valvuloplasty of the CoA was then performed using the same balloon; the pressure gradient decreased to 0 mmHg, and CoA diameter decreased from 2.1 to 5.5 mm. Cathet. Cardiovasc. Diagn. 45:51–53, 1998. © 1998 Wiley-Liss, Inc.     

A case of atypical aortic coarctation with refractory congestive heart failure-treatment with axillo-iliac artery bypass

Coarctation of the aorta is rare. We present a case of atypical coarctation due to aortitis syndrome with congestive heart failure refractory to conventional medical treatment. Although indications for surgical treatment are not well established and, in general, treatment of choice is an aorto-aortic bypass, we selected axillo-iliac bypass with subcutaneous tunnel because of severe heart failure. Postoperatively, the pressure gradient disappeared and heart failure was improved.     

Percutaneous treatment of late‐aortic pseudoaneurysm resulting from surgical repair of aortic coarctation

We describe the case of a 38‐year‐old woman who presented with symptoms of chest pain and shortness of breath that had worsened over the previous 6 months and was found to have a large pseudoaneurysm (PSA) of the thoracic aorta. She underwent surgical repair of aortic coarctation at the age of 16 and a revision of her bypass graft at age 28 when she presented with hemoptysis due to aortic PSA and aortobronchial fistula. Our cardiothoracic surgical team deemed a third surgery very high risk; therefore, she was referred to us for percutaneous repair of aortic PSA. We describe the successful treatment of the PSA using a technique of microcoil embolization and Amplatzer® vascular plug (AGA Medical Corp., Plymouth, MN).© 2011 Wiley‐Liss, Inc.     

新生儿主动脉缩窄的外科治疗

目的:回顾总结新生儿主动脉缩窄(Co A)的外科治疗经验,探讨新生儿期Co A的最佳手术时机及手术方式。方法:2010年7月至2014年3月,共收治新生儿Co A 31例,男性20例,女性11例。手术年龄9~30天,平均(24.8±6.1)天,体质量2~4.1kg,平均体质量(93.2±0.7)kg。合并心内畸形者23例,合并PDA者4例,单纯Co A 4例。一期手术21例;分期手术10例,首先于非体外循环下行Co A矫治+肺动脉环缩术,随访25天~12个月后再行心内畸形矫治术。Co A矫治的方法包括:缩窄段切除行端端吻合、扩大的端端吻合或端侧吻合术、扩大的端端吻合+补片成形术、左锁骨下动脉翻转主动脉成形术。结果:1例死于出血,病死率3.2%;1例术后心肺功能较差,无法撤离呼吸机,放弃治疗;术后无肾衰竭、左上肢缺血及神经系统并发症发生。全组术毕有创动脉监测上、下肢动脉平均压差7.2mm Hg(1mm Hg=0.133k Pa)较术前39.1mm Hg明显下降(P<0.05)。结论:严重的新生儿Co A,病情危重,需早期诊断、及时治疗;对于合并心内畸形者,若导致心功能不全的主要原因为Co A、不能耐受体外循环的患儿行分期手术安全可靠;Co A合并主动脉弓发育不良者,采应扩大端端吻合或端侧吻合术可获得满意疗效。     

Stent implantation for aortic coarctation and recoarctation

OBJECTIVE—To determine the early results of balloon expandable stent implantation for aortic coarctation or recoarctation.
DESIGN—Prospective observational study.
SETTING—Two paediatric cardiology tertiary referral centres.
PATIENTS—17 patients, median age 17 years (range 4.4 to 45) and median weight 61 kg (17 to 92). Six had native aortic coarctation and 11 had aortic recoarctation; 14 had upper limb systolic hypertension. Of those with recoarctation, eight had had at least one previous balloon dilatation attempt and two of these patients also had further surgical interventions.
INTERVENTION—Balloon expandable Palmaz iliac stent implantation.
MAIN OUTCOME MEASURES—Systolic pressures gradients, minimum aortic diameter, upper limb blood pressures, and incidence of aneurysm formation.
RESULTS—18 stents were implanted during 18 procedures in the 17 patients. Mean peak systolic pressure gradient fell from 26 mm Hg (95% confidence interval (CI), 21 to 31 mm Hg) before to 5 mm Hg (2 to 8 mm Hg) after stent implantation (p < 0.001), and mean minimum aortic diameter increased from 7 mm (95% CI, 6 to 8 mm) before to 11.3 mm (10 to 12.6 mm) after implantation (p < 0.001). Complications occurred in five patients (bleeding in two, stent migration in two, and aneurysm formation in one). Two patients remained borderline hypertensive and eight were receiving antihypertensive treatment at most recent assessment.
CONCLUSIONS—Stent implantation for aortic recoarctation and native coarctation gives good immediate results. Careful follow up is necessary to evaluate complications and the long term effect on blood pressure.


Keywords: coarctation; aortic recoarctation; stents