支架植入治疗儿童主动脉缩窄并高血压的可行性及近中期疗效

doi:10.6040/j.issn.1671-7554.0.2025.0343

摘要/Abstract

摘要： 目的分析支架植入治疗儿童主动脉缩窄(coarctation of aorta, CoA)并高血压可行性及近中期疗效分析。方法回顾分析5例(男3例、女2例,6~10岁)CoA并高血压患儿的临床特点、介入治疗、随访结果。结果手术成功率100%,术前主动脉压差28.0(25.5,33.0)mmHg(1 mmHg=0.133 kPa)降至术后5.0(3.5,6.5)mmHg,术前主动脉横径4.8(3.1,6.1)mm扩张至术后18.0(13.0,21.5)mm,2例患儿需持续口服单一抗高血压药物,随诊15个月未再发现支架移位、主动脉夹层、主动脉再缩窄等并发症。结论采用球囊扩张+支架植入治疗儿童CoA并高血压可取得即时及近中期疗效,但其远期效果仍需进一步随访观察。

关键词: 主动脉缩窄, 高血压, 儿童, 介入治疗, 支架

Abstract: Objective To evaluate the feasibility and short- to mid-term efficacy of stent implantation for the treatment of coarctation of the aorta(CoA)complicated by hypertension in children. Methods A retrospective analysis was conducted on five children(3 boys and 2 girls, aged 6-10 years)diagnosed with CoA and hypertension. The clinical cha-racteristics, procedural details of interventional therapy, and follow-up outcomes were reviewed. Results The procedural success rate was 100%. The median trans-coarctation pressure gradient significantly decreased from 28.0(25.5,33.0)mmHg(1 mmHg=0.133 kPa)preoperatively to 5.0(3.5,6.5)mmHg postoperatively. Concurrently, the median diameter at the coarctation site increased significantly from 4.8(3.1, 6.1)mm to 18.0(13.0,21.5)mm after stenting. Two children required continued oral antihypertensive therapy with a single agent. During a median follow-up period of 15 months, no complications such as stent migration, aortic dissection, or recoarctation were observed. Conclusion Balloon-expandable stent implantation is a feasible and effective treatment for children with CoA and hypertension, demonstrating excellent immediate and short- to mid-term outcomes. However, long-term follow-up is necessary to confirm its sustained efficacy.

Key words: Coarctation of the aorta, Hypertension, Children, Interventional therapy, Stent

中图分类号:

R725.4

孙红林,管玉强,于培儒,李磊,杜庆霞,丁浩. 支架植入治疗儿童主动脉缩窄并高血压的可行性及近中期疗效[J]. 山东大学学报 (医学版), 2026, 64(4): 58-62.

SUN Honglin, GUAN Yuqiang, YU Peiru, LI Lei, DU Qingxia, DING Hao. Feasibility and short-to-medium-term efficacy of stent implantation for the treatment of aortic coarctation complicated by hypertension in children[J]. Journal of Shandong University (Health Sciences), 2026, 64(4): 58-62.

参考文献

[1] Egbe AC, Miranda WR, Warnes CA, et al. Persistent hypertension and left ventricular hypertrophy after repair of native coarctation of aorta in adults[J]. Hypertension, 2021, 78(3): 672-680.
[2] Alvarez-Fuente M, Ayala A, Garrido-Lestache E, et al. Long-term complications after aortic coarctation stenting[J]. J Am Coll Cardiol, 2021, 77(19): 2448-2450.
[3] Flynn JT, Kaelber DC, Baker-Smith CM, et al. Clinical practice guideline for screening and management of high blood pressure in children and adolescents[J]. Pediatrics, 2017, 140(3): e20171904. doi: 10.1542/peds.2017-1904
[4] Chetan D, Mertens LL. Challenges in diagnosis and management of coarctation of the aorta[J]. Curr Opin Cardiol, 2022, 37(1): 115-122.
[5] Tanous D, Benson LN, Horlick EM. Coarctation of the aorta: evaluation and management[J]. Curr Opin Cardiol, 2009, 24(6): 509-515.
[6] Onalan MA, Temur B, Aydın S, et al. Management of aortic arch hypoplasia in neonates and infants[J]. J Card Surg, 2021, 36(1): 124-133.
[7] 曾洁敏, 黄萍, 王红英, 等. 主动脉缩窄矫治术后血管内皮功能近中期随访[J]. 实用医学杂志, 2016, 32(8): 1247-1249. ZENG Jiemin, HUANG Ping, WANG Hongying, et al. Early and midterm follow-up of vascular endothelial function in children with surgical repair for coarctation of aorta[J]. The Journal of Practical Medicine, 2016, 32(8): 1247-1249.
[8] Egbe AC, Anderson JH, Karnakoti S, et al. Assessment of coarctation of aorta gradient: echocardiogram-catheterization correlation[J]. Am J Cardiol, 2023, 205: 420-421. doi: 10.1016/j.amjcard.2023.08.083
[9] Heremans L, Henkens A, de Beco G, et al. Results of coarctation repair by thoracotomy in pediatric patients: a single institution experience[J]. World J Pediatr Congenit Heart Surg, 2021, 12(4): 492-499.
[10] Gropler MRF, Marino BS, Carr MR, et al. Long-term outcomes of coarctation repair through left thoracotomy[J]. Ann Thorac Surg, 2019, 107(1): 157-164.
[11] Minotti C, Scioni M, Castaldi B, et al. Effectiveness of repair of aortic coarctation in neonates: a long-term experience[J]. Pediatr Cardiol, 2022, 43(1): 17-26.
[12] Eldadah OM, Alsalmi AA, Diraneyya OM, et al. Progressive changes in residual gradient after aortic coarctation repair and its role in the prediction of reintervention: a longitudinal data analysis[J]. Ann Pediatr Cardiol, 2023, 16(3): 182-188.
[13] Kavurt AV, Gürsu HA, Kaş G, et al. Early outcomes of the treatment of aortic coarctation with BeGraft aortic stent in children and young adults[J]. Cardiol Young, 2023, 33(3): 354-361.
[14] 王一彪, 隋树建, 张瑞芹, 等. 经皮球囊血管成形术治疗先天性主动脉缩窄中长期疗效观察[J]. 山东大学学报(医学版), 2003, 41(5): 547-548. WANG Yibiao, SUI Shujian, ZHANG Ruiqin, et al. Effect and follow up of percutaneous balloon dilatation angioplasty for the treatment of congenital coarctation of the aorta[J]. Journal of Shandong University(Health Sciences), 2003, 41(5): 547-548.
[15] 张洪宇, 王为新, 乔衍礼. 外科手术治疗主动脉缩窄39例报告[J]. 山东大学学报(医学版), 2011, 49(9): 160-162.
[16] Ahmadi A, Mansourian M, Sabri MR, et al. Follow-up outcomes and effectiveness of stent implantation for aortic coarctation: a systematic review and meta-analysis[J]. Curr Probl Cardiol, 2024, 49(6): 102513. doi: 10.1016/j.cpcardiol.2024.102513
[17] Hámdan MA, Maheshwari S, Fahey JT, et al. Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up[J]. J Am Coll Cardiol, 2001, 38(5): 1518-1523.
[18] Contrafouris C, Antonopoulos CN, Rammos S, et al. Evaluating the effectiveness of stenting for aortic coarctation[J]. Aorta(Stamford), 2022, 10(5): 235-241.
[19] Suárez de Lezo J, Pan M, Romero M, et al. Immediate and follow-up findings after stent treatment for severe coarctation of aorta[J]. Am J Cardiol, 1999, 83(3): 400-406.
[20] Berman DP, Morray B, Sullivan P, et al. Results of the multicenter early feasibility study(EFS)of the Renata Minima stent as treatment for branch pulmonary artery stenosis and coarctation of aorta in infants[J]. Catheter Cardiovasc Interv, 2024, 104(1): 61-70.
[21] Hatoum I, Haddad RN, Saliba Z, et al. Endovascular stent implantation for aortic coarctation: parameters affecting clinical outcomes[J]. Am J Cardiovasc Dis, 2020, 10(5): 528-537.
[22] Mortezaeian H, Rezanejad E, Pasebani Y, et al. Five-year outcomes of coarctoplasty with stents in the pediatric population: results from a retrospective single-center cohort with centrally adjudicated outcomes[J]. Pediatr Cardiol, 2025, 46(5): 1312-1319.
[23] Colle A, Enciso SK, Brunee L, et al. Aortic coarctation stenting in adolescents and adults: a single-center expe-rience[J]. Vasc Endovascular Surg, 2023, 57(8): 863-868.
[24] Clare J, Ganly J, Bursill CA, et al. The mechanisms of restenosis and relevance to next generation stent design[J]. Biomolecules, 2022, 12(3): 430. doi: 10.3390/biom12030430
[25] Alberti S, Zhang QQ, DAgostino I, et al. The antiplatelet agent revacept prevents the increase of systemic thromboxane A2 biosynthesis and neointima hyperplasia[J]. Sci Rep, 2020, 10(1): 21420. doi: 10.1038/s41598-020-77934-x
[26] Rao PS. Stents in treatment of aortic coarctation[J]. J Am Coll Cardiol, 1997, 30(7): 1853-1855.
[27] Rao PS. Balloon dilatation in the management of conge-nital obstructive lesions of the heart: review of authors experiences and observations-part II[J]. J Cardiovasc Dev Dis, 2023, 10(7): 288. doi: 10.3390/jcdd10070288
[28] 金屏, 刘洋, 唐嘉佑, 等. 经皮球囊扩张式覆膜支架置入治疗先天性主动脉缩窄的临床疗效分析[J]. 中国体外循环杂志, 2018, 16(6): 366-368. JIN Ping, LIU Yang, TANG Jiayou, et al. Clinical efficacy of percutaneous balloon dilatation covered stent implantation for congenital coarctation of the aorta[J]. Chinese Journal of Extracorporeal Circulation, 2018, 16(6): 366-368.
[29] Kasar T, Erkut O, Tanidir IC, et al. Balloon-expandable stents for native coarctation of the aorta in children and adolescents[J]. Medicine(Baltimore), 2022, 101(51): e32332. doi: 10.1097/MD.0000000000032332

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