心包补片和肺动脉补片治疗婴幼儿主动脉缩窄合并主动脉弓发育不良的疗效比较

徐海涛，王强，李巅远，郭宏伟，李守军，王菊，段亚冰，闫军



心包补片和肺动脉补片治疗婴幼儿主动脉缩窄合并主动脉弓发育不良的疗效比较

徐海涛，王强，李巅远，郭宏伟，李守军，王菊，段亚冰，闫军

摘要

关键词主动脉缩窄；主动脉，胸；血管成形术

作者单位：100037 北京市，北京协和医学院 中国医学科学院 国家心血管病中心 阜外医院 小儿心脏外科中心

Comparative Study of Autologous Pericardium Patch and Pulmonary Patch for Treating the Infants With Aortic Coarctation Combining Hypoplastic Aortic Arch

XU Hai-tao,WANG Qiang,LI Dian-yuan,GUO Hong-wei,LI Shou-jun,WANG Ju,DUAN Ya-bing,YAN Jun.
Department of Pediatric Cardiac Surgery,Cardiovascular Institute and Fu Wai Hospital,CAMS and PUMC,Beijing(100037),China
Corresponding Author:YAN Jun,Email:yanjun.1112@aliyun.com

Abstract

Objective:To compare the effects of pericardium patch aortoplasty and pulmonary patch aortoplasty for treating the infants with aorticcoarctation(AC)combining hypoplastic aortic arch in order to provide a better surgical choice in clinical practice.

Methods:A total of 57 patients with AC combining hypoplastic aortic arch treated in our hospital from 2009-01 to 2014-12 were retrospectively studied.The patients were divided into 2 groups:Pericardium patch aortoplasty group,n=26 and Pulmonary patch aortoplasty group,n=31.The changes of the pressure gradient at post-operation and follow-up period were compared.

Results:There were 2/57(3.5%)patients died,1 in Pericardium patch aortoplasty group by pulmonary hypertension crisis,the other 1 in Pulmonary patch aortoplasty group by respiratory distress syndrome.No renal failure or neurologicalcomplication occurred in neither groups.The cardiopulmonary bypass time,aortic clamping time,ventilator time and ICU stay time were similar between 2 groups,P>0.05.Selective cerebral perfusion time in Pericardium patch aortoplasty group was shorter than Pulmonary patch aortoplasty group(30.5 ± 8.6)s vs(35.6 ± 10.3)s,P<0.05.By ultrasound estimation,the post-operative AC pressure gradients were decreased than they were before,as in Pericardium patch aortoplasty group(9.5 ± 7.5)mmHg vs(39.9 ± 15.5)mmHg and in Pulmonary patch aortoplasty group(11.8 ± 11.3)mmHgvs(39.2 ± 14.5)mmHg,both P<0.05;while post-operative pressure gradients were similar between 2 groups,P>0.05.Follow-up study was conducted in 51 patients for(17.6 ± 16.6)months,Pericardium patch aortoplasty group had 6 patients with re-stenosis,3 of them would receive balloon angioplasty and 3 would be continuously followed-up;Pulmonary patch aortoplasty group had 6 patients with re-stenosis,2 of them finished balloon angioplasty and their pressure gradients were obviously decreased,4 would be continuously followed-up.Kaplan-Meier curves presented that Pulmonary patch aortoplasty group was superior to Pericardium patch aortoplasty group in re-stenosis occurrence during follow-up period.

Conclusion:Both pericardium patch aortoplasty and pulmonary patch aortoplasty were effective for treating the patients with AC combining hypoplastic aortic arch,the early post-operative efficacy was similar,while the mid-term follow-up result was better in pulmonary patch aortoplasty.

Key words Aortic coarctation;Aorta,thoracic;Angioplasty

(Chinese Circulation Journal,2016,31:280.)

主动脉缩窄（coaretation of aorta，CoA）指胸降主动脉先天性局限性狭窄，狭窄区域一般在动脉导管和主动脉连接处，但是部分婴幼儿常合并主动脉弓发育不良，这类患儿病情复杂，病死率高。目前，对于这类患儿，治疗方案主要有两种：缩窄段切除加端端（或端侧）吻合和缩窄段切除加主动脉弓补片成形术[1]。文献报道缩窄段切除加扩大端端（或端侧）吻合技术改变了主动脉弓的几何形态，而且上提降主动脉易造成吻合口张力变大，增加了术后罹患高血压和吻合口再狭窄的概率[2]。2009 -01至2014-12期间，我们共收治57 例主动脉缩窄合并主动脉弓发育不良患儿，手术中采用主动脉弓心包补片成形或主动脉弓肺动脉补片成形技术处理主动脉弓发育不良，现对两种手术方法的优缺点以及手术疗效进行讨论，旨在为临床该类疾病的治疗提供更加合理地选择。

1　资料与方法

临床资料和分组：57 例主动脉缩窄合并主动脉弓发育不良患儿中，男性38 例（67%），女性19 例（33%）；全组均合并其它心内畸形，其中合并室间隔缺损43例（75%），房间隔缺损31 例（54%），动脉导管未闭25 例（……