| Objective The coarctation resection and aortoplasty with autologous pulmonary artery patch and extended end-to-side and end-to-end anastomosis were the commonly used surgical techniques of coarctation of the aorta and hypoplastic aortic arch(CoA/HAA).However,the application of these two techniques was still confusing.In order to analyze the application of coarctation resection and aortoplasty with autologous pulmonary artery patch in infant,we reviewed and summarized the clinical data of infants with coarctation of aorta that underwent surgical treatment in our hospital,and then discussed the effects of other related surgical methods and patch materials.Methods Clinical data of 21 infants with CoA/HAA,who underwent coarctation resection and aortoplasty with autologous pulmonary artery patch in our hospital from January 2009 to June 2016,were retrospectively analyzed.The age of the patients was 4(2,5)months and the body weight of the patients was(5.3±1.6)kg.The patients were followed up to observe the surgery effect.Results(1)No perioperative death and serious complications occurred.When the patients were discharged,the systolic blood pressure of the right upper limb was lower than the preoperative systolic blood pressure((85.71 ± 5.91)mmHg(1 mmHg=0.133 kPa)vs.(100.71 ± 16.55)mmHg,p<0.001),and the systolic blood pressure of the right lower limb was higher than the preoperative systolic blood pressure((98.71 ± 13.26)mmHg vs.(85.57 ± 20.80)mmHg,p<0.001).The pressure gradient of aortic coarctation detected by echocardiography was lower than the preoperative pressure gradient((13.14± 3.80)mmHg vs.(46.22 ± 17.13)mmHg,p<0.001).No restenosis was detected by echocardiography at discharge.(2)Follow-up data were obtained in 19 patients,and the follow-up time was 18(8,45)months.The patients grow well,and no death occurred.Restenosis occurred in 3 cases,1 patient underwent aortic balloon dilatation and the remaining 2 patients were under follow up observation.Computed tomography angiography showed that the morphology of aortic arch was normal without signs of aortic aneurysm.Conclusion Coarctation resection with autologous pulmonary artery patch aortoplasty is considered as a safe and effective surgical method for management of infant complicated CoA/HAA,which had good outcomes in restore the tubular structure and maintain the normal geometry of the aortic arch.Objective The condition of the children with coarctation of the aorta(CoA)and complex cardiac anomalies is often severe.The design of surgical strategies remains controversial.In this study,we reviewed and summarized the clinical data of infants and young children with CoA and complex cardiac anomalies in our hospital,in order to analyse the operative effect and surgical strategy,and then provide support for the design of clinical decision and individualized treatment plan.Methods From 2007-01 to 2016-06,a total of 16 infants and young children with CoA and complex cardiac anomalies underwent surgical correction in our hospital were retrospectively analyzed.The age of the patients was 4.0(2.0,7.8)months and the body weight of the patients was(6.18 ± 2.61)kg.15 patients underwent surgical correction at one stage.5 patients diagnosed as simple CoA underwent end-to-end anastomosis.The other 11 patients with aortic arch hypoplasia,one underwent expanded end-to-end anastomosis,10 underwent coarctation resection and patch aortoplasty.Results(1)There was one hospital death,died of pulmonary hypertension,cerebral injury and right heart failure.Serious complications occurred in 4 patients,the complications were relieved after symptomatic treatment.(2)When the patients were discharged,the systolic blood pressure of the right upper limb was lower than the preoperative systolic blood pressure((86.19± 8.48)mmHg(1 mmHg=0.133 kPa)vs.(88.50 ± 14.22)mmHg,p>0.05),and the systolic blood pressure of the right lower limb was higher than the preoperative systolic blood pressure((97.69 ± 9.51)mmHg vs.(84.50 ± 19.44)mmHg,p<0.01).The pressure gradient of aortic coarctation detected by echocardiography was lower than the preoperative pressure gradient[(16.19± 3.78)mmHg vs.(28.63 ± 6.31)mmHg,p<0.01].No restenosis was detected by echocardiography at discharge.(3)Follow-up was carried out in 15 cases,the follow-up time was 44(30,80)months.The patients grow well,and no death occurred.Restenosis occurred in 4 cases,and were under follow up observation.Conclusion The condition of infants and young children with CoA and complex cardiac anomalies are always complicated.It is important that individual treatment strategies should be cautiously made based on the age and condition of children.One stage repair of CoA and complex cardiac anomalies through median sternotomy has good early and mid-term outcomes,but high complication risk.Therefore,maybe we need to pay more attention to the long-term impact of surgical risk on the children,instead of focusing solely on whether the surgical treatment is complete or not. |
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