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目的总结儿童主动脉缩窄(coarctation of aorta,COA)诊断和治疗中的经验教训。方法2000年1月～2006年7月6年间在我院确诊并接受了内外科治疗的75例7岁以下COA病例,对一般临床资料、超声心动图、磁共振(MRI)和选择性心血管造影结果、手术方法、随访结果和预后进行分析。结果外科治疗组(52例):住院期间死亡2例(3.85%),存活的50例经1个月～6年的随访,治愈47例,3例术后1～2年证实再缩窄行球囊扩张术。内科治疗组(23例):20例单纯、局限的COA行球囊扩张术,1例再狭窄行2次球囊扩张;3例合并弓发育不良的COA行球囊扩张,有2例症状复发,其中1例因重度肺动脉高压放弃外科手术治疗,1例扩张后2年行外科手术治疗。结论COA治疗上以外科手术为主,手术方法有补片加宽、切除端端吻合、左锁骨下动脉翻转等,合理选择术式效果令人满意;单纯、局限的COA和外科手术纠正后发生的再狭窄是球囊扩张术的较好指征,球囊扩张术对合并弓发育不良的COA的疗效不佳。
Objective To summarize the experiences in the diagnosis and treatment of children with coarctation of aorta (COA). Methods Seventy-five COA cases under the age of 7 were diagnosed in our hospital from January 2000 to July 2006, and received surgical and surgical treatment. General clinical data, echocardiography, magnetic resonance imaging (MRI), and selective cardiovascular Angiography, surgical methods, follow-up results and prognosis. Results Surgical treatment group (52 cases): 2 cases died during hospitalization (3.85%), 50 cases survived after 1 month to 6 years follow-up, 47 cases were cured, 3 cases were confirmed 1 to 2 years after re-constriction Balloon dilatation. In the medical treatment group (23 cases), 20 cases were simple and limited COA balloon dilatation and 1 case restenosis was performed 2 times balloon dilatation. In 3 cases with underdeveloping COA, balloon dilatation was performed, and 2 cases relapsed , Of which 1 case was given surgical treatment due to severe pulmonary hypertension and 1 case was surgically treated 2 years after dilatation. Conclusions The main surgical treatment for COA is surgical operation, such as patch widening, anastomosis at the resection end, overturning of the left subclavian artery and so on. The reasonable choice of surgical procedure is satisfactory. Simple and limited COA and surgical correction Restenosis is a good indication of balloon dilatation and balloon dilatation is not effective in patients with poorly developed COA.