| Background and objective:Coarctation of the aorta(COA)is a kind of local stenosis of the aorta,which causes the obstruction of blood flow.Coarctation can occur in any part of the aorta.The most common part is between the arterial duct and the beginning of the left subclavian artery.Morgagni,an Italian anatomist,first reported coarctation of the aorta in the 18 th century.Generally,coarctation of the aorta often combines with other congenital malformations,For example,bicuspid aortic malformation,ventricular septal defect(VSD),patent ductus arteriosus(PDA),mitral valve malformation,Persistent left superior vena cava(PLSVC),right aortic arch,transposition of great artery(TGA)and unilateral anomalous connection of pulmonary vein.Coarctation of the aorta accounts for 5%-10% of congenital heart disease.4 out of every 10000 living babies may have coarctation of the aorta,ranking fifth in congenital heart disease.The incidence rate of male is higher than that of female,and the ratio of male to female is about 2:1.In an age without surgery,the survival time of patients with coarctation of the aorta was only 31 years.In 1940 s,Crawford first performed surgery on patients with coarctation of the aorta.Since then,there have been surgical schemes such as coarctation resection + extended end-to-end anastomosis to treat coarctation of the aorta.In 1961,Vosschulte reported that using patch technology to widen the aorta,There are artificial patch,homograft patch and xenograft patch.In 1992,Roussin applied the technique of autologous pulmonary artery patch,there was no postoperative coarctation,the mortality was about 13%,the rate of pulmonary artery stenosis was about 5%,there was no pulmonary valve problem.According to the different operation methods,the patients who underwent the operation were divided into autologous pulmonary artery patch group and other operation methods group,To explore the best surgical treatment for coarctation of the aorta.Methods:From 2017 to 2019,49 patients with coarctation of the aorta(n = 10)and coarctation of the aorta with multiple cardiovascular malformations(n = 39)were selected by retrospective analysis.According to the different surgical methods,the patients were divided into two groups: group 1 was used to correct coarctationof aorta with autologous pulmonary artery patch(n = 22),group 2 was used to correct coarctation of aorta with other surgical methods(n = 27),including end-to-end anastomosis(n = 10),other patch techniques(n = 6)and end-to-side anastomosis(n = 11).All the patients in the two groups were treated with other cardiovascular malformations at the same time.SPSS 24.0 software was used for statistical analysis.The general data of the patients were analyzed,including hospitalization number,name,age,gender.The indexes of echocardiography included systolic pressure difference,combined malformation,pulmonary artery pressure,aortic arch index.The biochemical indexes included neutrophil,lymphocyte,blood type,platelet,hemoglobin,C-reactive protein(CRP).The operation data included aortic occlusion time,cardiopulmonary bypass time,mechanical ventilation time,the time of staying in the ICU and the total length of stay in the hospital.All the children who were followed up had their echocardiogram,chest radiograph and electrocardiograph reexamined regularly in the outpatient department.The patients who were prompted by echocardiogram to be recoarctated were examined by CT or angiocardiography in the hospital to determine whether the second intervention was needed.The pressure difference between the upper and lower limbs and the recoarctation during the follow-up of the two groups were detected,At the same time,analyze the difference between the children with and without recoarctation.Results:After the operation,the upper limb pressure of 20 patients was higher than that of the lower limb,and the pressure gradient was less than 30 mm Hg.The pressure of upper limb and lower limb were equal in 10 patients.The pressure of lower extremity was higher than that of upper extremity in the other 19 patients.There were 2cases of ventricular fibrillation,2 cases of hemorrhage and 1 case of death after operation.There was no significant difference in aortic occlusion time,cardiopulmonary bypass time,mechanical ventilation time,ICU monitoring time and total length of stay between the two groups(P > 0.05).48 patients were followed up after discharge,the follow-up time was 186 ± 149(2-589)days,the upper and lower limb pressure difference was 14(8,75)mm Hg,aortic arch index was 0.7(0.6,0.8),there were 2 cases(9%)of recoarctation,of which 1 case was treated with balloon angioplasty due to recoarctation,and the postoperative pressure difference was reduced to normal level,and 1 case had pulmonary stenosis.During the follow-up period of group 2,thepressure difference between the upper and lower limbs was 20(13,24)mm Hg,the arch index was 0.6(0.6,0.7),and 9 cases(34%)were treated with recoarctation.Among them,1 case was treated with balloon aortoplasty due to recoarctation.Compared with the two groups,the number of people in group 1 who suffered from recoarctation was lower than that in group 2,there was no significant difference between the two groups(P <0.05).There was no significant difference between the two groups(P > 0.05)in pressure of narrowing section and aortic arch index at the last follow-up.There were 11 patients with recoarctation and 37 children without recoarctation.The last follow-up aortic arch index of the recoarctation group was 0.6(0.5,0.7),On the first day after operation,the hemoglobin content was 108(101,124)g / L,the CRP level was 16(6,30)mg / L.The last follow-up aortic arch index of the without recoarctation group was 0.7(0.6,0.9),the hemoglobin content was120(109,139)g / L on the first day after operation,and the CRP level was 49(29,77)mg / L on the first day after operation,The last follow-up aortic arch index,hemoglobin content on the first day after operation and CRP level on the first day after operation were lower in the group of children with recoarctation than that in the group without recoarctation(P < 0.05).Conclusions:Because of the regenerative potential of the autologous pulmonary artery patch,the pressure difference between the upper and lower extremities can be reduced or even disappeared in the early postoperative period,and the aortic arch index can be increased.At the same time,the rate of recoarctation is low.The hemoglobin content and CRP level in the blood of the children with recoarctation decrease on the first day after operation. |
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