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目的 总结小儿主动脉缩窄 (COA)诊断和治疗中的经验教训。方法 收集 10年来 (1993年 6月至 2 0 0 3年 12月 )在广东省心血管病研究所确诊并接受了手术治疗的 5 4例 14岁以下COA病例 ,对一般临床资料、超声心动图、螺旋CT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 超声心动图漏诊或误诊 7例 ;住院期间死亡 5例 (9 2 6 % ) ,其中 4例为 1～ 6个月的婴儿 ,存活的 4 9例经 3个月到 7年的随访 ,治愈 4 5例。有 2例行左锁骨下动脉翻转术者 ,术后 1～ 2年证实再缩窄而再次手术。结论 在COA的诊断上 ,超声心动图仍有一定的局限性 ,对婴幼儿及危重患儿疑有COA而不宜进行心导管检查者可将螺旋CT检查作为首选。手术方式以端端吻合预后最好。术后主要死亡因素是合并其它心内复杂畸形及重度肺动脉高压。
Objective To summarize the experience of diagnosis and treatment of pediatric aortic constriction (COA). Methods A total of 54 cases of COA under 14 years of age confirmed by the Institute of Cardiovascular Disease of Guangdong Province from June 1993 to December 2003 were collected. The clinical data, echocardiography , Spiral CT and echocardiographic findings, surgical procedures, follow-up results, and prognosis. Results Echocardiography missed or misdiagnosed in 7 cases. There were 5 deaths (92.6%) during hospitalization, of which 4 were infants from 1 to 6 months and 49 survived after 3 months to 7 years of follow-up. 45 cases. There are 2 cases of left subclavian artery twitch surgery who confirmed 1 to 2 years after the re-narrowing and reoperation. Conclusion In the diagnosis of COA, echocardiography still has some limitations. For infants and critically ill children suspected of having COA but not for cardiac catheterization, spiral CT may be the first choice. Surgery to end the best anastomosis. The major cause of death after surgery was the combination of other intracardiac complex deformities and severe pulmonary hypertension.