| Research purpose1.Summary of morphological characteristics and clinical manifestations adult aortic coarctation.2.Evaluation of clinical effect for different methods of endovascular treatment of adult aortic coarctation.3.Evaluation of clinical effect for different methods of surgical treatment of adult aortic coarctation.4.Comparison of clinical effect and cost-benefit analysis between intervention and surgical treatment for adult aortic coarctation,aiming to guide how to make plan for different methods of adult aortic coarctation.Materials and MethodsCase from the patients with adult aortic coarctation in our hospital from February to June 2016.Detailed medical records,operation process and postoperative follow-up of Patients with aortic coarctation will be recorded,including clinical manifestations,narrowed shape,surgical form and clinical effect.Imaging tests include: CT evaluation of aortic morphology,echocardiographic evaluation of cardiac structure and function,DSA angiography evaluation for narrowed morphology and measurement for arterial blood pressure.Records about the changes of instant and follow-up narrow degree and arterial blood pressure;Record and comparison of the differences for blood pressure of upper extremity and pulse pressure of upper-lower extremity after preoperation,postoperation and final follow-up as well as the case oforal antihypertensive drugs.Review and analysis on the occurrence,types and reasons of complications;analysis and comparison of the clinical effect for different forms of coarctation of the aorta used different surgical treatment;analysis on the best treatment strategy for different morphological features.ResultAccording to morphology and cardiovascular malformations,This group can be divided into 24 cases of simple aortic coarctation,accounting for 61.5%,complex in10 cases,accounting for 25.6% and complications in 5 cases,accounting for 13.8%,with narrowed length from 3mm to 60 mm,average length 9.22 ± 4.94 mm.Narrowest diameter is 1.7-6.0mm and an average one is 3.55 ± 1.58 mm.DAo is 0.10-0.6 and average one is 0.35.Among this group,27 cases for hypertension treatment account for 69%,followed by chest pain in 5 cases,accounting for 12.8% and thoracic aortic aneurysm examination found three cases(7.7%),heart failure(congenital heart disease)2 cases(5.1%),cerebral hemorrhage 1 case(2.5%).39 patients successfully performed the operation,with 100% success rate.As for intervention in 25 cases,they include: one case of transluminal balloon dilatation,20 cases of stent implantation(14 cases of balls expanding stents,6 cases of self-expanding stents),14 cases of surgery.Among the 14 cases of surgery,they include 5 cases of Ascending aorta-abdominal aorta bypass surgery,5 cases of aortic coarctation correction,ascending aorta-abdominal aorta bypass for joint cardiac malformation treatment in 4 cases(Joint atrial septal repair in one cases,Joint septal repair in two cases,joint Bentall's surgery in one case).Instant pulse pressure between upper and lower extremity after surgery decreased obviously((52.7±15.1mmHg vs 6.41±5.47 mmHg).Blood pressure of upper extremity decreased significantly after surgery,15 patients do not need to take oral antihypertensive drugs again.20 patients only need to take one kind of oral antihypertensive drugs,4 patients required to take two kinds of oral antihypertensive drugs.The effect of interventional surgery showed that simple aortic coarctation is better than complex onein the terms of instant value of PSG,DAo and the differencesin pulse pressure after surgery.There is no differences in postoperative blood pressure of upper extremity and the types of oral antihypertensive drugs after patients discharged.During the long-term and middle-term follow-up,patients with simple type are better than ones with complex type in the blood pressure of upper extremity and oral antihypertensive drugs as well as pulse pressure of upper and lower extremities was no significant difference.The effect of surgery showed that there was no significant differences between the three sub-type in the immediate postoperative pulse pressure of upper and lower extremities.Early postoperative blood pressure of upper extremity,the pressure difference between the upper and lower extremities and the types of oral antihypertensive drugs had no significant differences.During long-middle follow-up,patients with simple and complex type were better than ones with complications concerning blood pressure of upper extremity,pulse pressure differences between the upper and lower extremities,oral antihypertensive drugs.Patients with simple and complications type had no clear differences.There was no significant difference between interventional surgery group and surgery group in terms of upper and lower limbs' pulse pressure,upper limb blood pressure,pulse pressure and types of enalapril meleate.In addition,among both simple type patients and complex patients,two methods did not show much differences in terms of the upper and lower limbs' pulse pressure,upper limb blood pressure,pulse pressure and types of enalapril meleate.During the perioperative period,there were six complications,two of which were in intervention group and four of which in surgical group.The hospitalization of two groups of patients were(13.12±3.46)days and(23.28±8.97)days respectively,among which there were significant differences;the average hospitalization expenses of the two groups of patients were(117.6±10.0)and(140.8±31.0)Thousand yuan respectively,among which there were statistic differences.In the interventional surgery group,there was one case of complex early death;no complication was found in flup,and no restenosis occurred.Conclusion1.A variety of treatment methods in the treatment of aortic constriction can significantly reduce the upper and lower pressure differences,relieve symptoms of hypertension.The middle and long term curative effect are both obvious;2.According to morphological features and clinical manifestations,aortic coarctation can be divided into simple and complex types(with aortic dissection or aneurysm)and complications(combined with other cardiovascular malformations).The curative effect of simple type is better than complex type in both interventional operations and surgical operations;3.The therapeutic effects of interventional surgery and surgical intervention are relevant.Relatively speaking,interventional operation has smaller trauma,less complication,shorter hospitalization time,lower hospitalization expenses and better cost-benefit ratio;as for any other cardiovascular malformations,surgical treatment can deal with them as the same time,the advantages of which are obvious;4.As for complex aortic banding with aortic dissection,the treatment's risk is higher.Due to the cases are far from enough,treatment experience and efficacy are to be discussed in the future with more clinical data. |
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