小婴儿重症主动脉缩窄经皮球囊扩张成形术治疗6例随访观察

目的 分析经皮球囊扩张成形术在小婴儿重症主动脉缩窄中的即刻治疗效果及6~49个月的随访情况。方法 对2006至2009年于复旦大学附属儿科医院施行经皮球囊扩张成形术的重症主动脉缩窄的<6月龄患儿行主动脉形态学和血液动力学指标的评价，于术后~2周、~6个月、~12个月及之后每年1次临床随访，随访内容包括股动脉损伤、主动脉再狭窄、左室收缩功能和是否有动脉瘤形成。结果 重症主动脉缩窄行经皮球囊扩张成形术6例患儿中，男4例，女2例；年龄32~153 d，平均（91±44）d；体重3.0~6.0 kg，平均（4.7±1.0）kg。6例患儿术前均表现为不同程度心功能不全，2例出现心源性休克合并严重代谢性酸中毒。经皮球囊扩张术后即刻，导管测量缩窄前后压力阶差由术前的（46±11）mmHg（1 mmHg=0.133 kPa）降至术后的（14±7）mmHg，5例术后跨缩窄压差均＜20 mmHg，1例极重度主动脉缩窄患儿由术前的76 mmHg降至术后的32 mmHg，下降幅度＞50%，6例均即刻成功。经皮球囊扩张术后主动脉缩窄部直径由术前的（2.18±0.48）mm扩大至术后的（4.00±0.83）mm，1例患儿术后有动脉瘤形成。随访6~49个月，6例患儿临床心功能不全症状均消失；2例因主动脉再狭窄行第2次经皮球囊扩张术；1例并发动脉瘤患儿在随访18个月后动脉瘤自行消失。结论 对重症主动脉缩窄合并左心功能不全的<6月龄患儿，经皮球囊扩张成形术可作为一种安全有效的替代外科手术的治疗方法，但其远期疗效及并发症尚有待进一步随访。

Balloon angioplasty of critical aortic coarctation in infants younger than 6 months: six case follow-up study

Objective To investigate the immediate efficacy, complications and midterm outcomes of balloon angioplasty in young infants with critical aortic coarctation who presented with left ventricular dysfunction. Methods The clinical data of children younger than 6 months with discrete native coarctation, who underwent balloon angioplasty from 2006 to 2009 in our institute, were retrospectively collected. All the procedures were performed under general anesthesia, using a retrograde femoral artery approach. During the procedures, the peak-to-peak gradient was recorded on pullback, and an aortogram was obtained in lateral and antero-posterior views. Results All six patients presented with clinical signs of left ventricular dysfunction and significant cardiomegly on chest X-ray. The mean age was (91±44) d and mean weight was (4.7±1.0) kg. Successful reduction in the post angioplasty gradient (＜20 mmHg) was achieved in 5 patients and decreased in gradient by more than 50% in one patient. Six cases were all immediate successful. There were significant improvements in pre versus post angioplasty coarctation diameters ［(2.18±0.48) vs (4.00±0.83) mm］ and systolic gradient across the coarctation site ［(46±11) vs (14±7) mmHg］. The follow-up time was ranged from 6 to 49 months. Left ventricular dysfunction was reversed in all patients shortly after balloon angioplasty combined with medical treatments. There were 2 cases of restenosis, who were successfully relieved by the repeat balloon angioplasty and free from restenosis in the follow-up period. One infant showed aneurysm formation after the initial angioplasty, which regressed spontaneously over 18 months when the repeat angioplasty was performed. No aneurysm formation was found after the second balloon dilation. Conclusions The preliminary experience suggests that in infants younger than 6 months with critical native coarctation, balloon angioplasty can be used as a life-saving alternative to surgical repair. However, long-term follow-up is mandatory to the evaluation of the procedure-related complication, including restenosis, aneurysm formation and approach artery injury.