CAJ | 학술논문

目的探讨主动脉缩窄矫治术后近、中期血管结构与功能改变.方法选取20例确诊主动脉缩窄(CoA)并行手术矫治的患儿(CoA组),其中单纯性主动脉缩窄6例,复合性主动脉缩窄(合并其他心内畸形)14例；同期20例单纯室间隔缺损(VSD)患儿(VSD组)作对照,均于术前至术后1年监测血压,超声下颈总动脉内中膜厚度(IMT)和肱动脉血流介导的血管舒张功能(FMD).20例健康儿童(健康组)进行1年的随访.结果术前、术后1个月、术后6个月、术后1年3组均无高血压临床表现.CoA组的颈总动脉IMT[(0.47±0.10) mm,(0.49±0.10) mm、(0.57±0.07) mm、(0.61±0.07)mm]均高于同期的VSD组[(0.41±0.11) mm,(0.43±0.11) mm,(0.51±0.08) mm,(0.55±0.08) mm]与健康组[(0.40±0,09) mm、(0.42±0.11) mm、(0.50±0.08)mm、(0.57±0.08) mm],差异均有统计学意义,P＜0.05.CoA组的肱动脉FMD[(5.46±1.51)％、(5.71±1.88)％、(5.42±1.69)％、(5.27±1.02)％]均明显低于VSD组[(6.69±1.45)％、(6.66±1.21)％、(6.81±1.03)％、(6.43±1.34)％]和健康组[(6.59±1.84)％,(6.84±1.41)％、(6.91±1.31)％、(6.56±1.62)％],差异均有统计学意义,P＜0.05.而上述两个指标在VSD组与健康组之间均差异无统计学意义,P＞0.05.结论主动脉缩窄矫治术后患儿仍存在血管结构和内皮功能异常,提示手术纠治主动脉缩窄后血管损害持续存在,可能是主动脉缩窄矫治术后患儿心血管疾病发生率高于健康儿童的原因.
목적 탐토주동맥축착교치술후근、중기혈관결구여공능개변.방법 선취20례학진주동맥축착(CoA)병행수술교치적환인(CoA조),기중단순성주동맥축착6례,복합성주동맥축착(합병기타심내기형)14례；동기20례단순실간격결손(VSD)환인(VSD조)작대조,균우술전지술후1년감측혈압,초성하경총동맥내중막후도(IMT)화굉동맥혈류개도적혈관서장공능(FMD).20례건강인동(건강조)진행1년적수방.결과 술전、술후1개월、술후6개월、술후1년3조균무고혈압림상표현.CoA조적경총동맥IMT[(0.47±0.10) mm,(0.49±0.10) mm、(0.57±0.07) mm、(0.61±0.07)mm]균고우동기적VSD조[(0.41±0.11) mm,(0.43±0.11) mm,(0.51±0.08) mm,(0.55±0.08) mm]여건강조[(0.40±0,09) mm、(0.42±0.11) mm、(0.50±0.08)mm、(0.57±0.08) mm],차이균유통계학의의,P＜0.05.CoA조적굉동맥FMD[(5.46±1.51)％、(5.71±1.88)％、(5.42±1.69)％、(5.27±1.02)％]균명현저우VSD조[(6.69±1.45)％、(6.66±1.21)％、(6.81±1.03)％、(6.43±1.34)％]화건강조[(6.59±1.84)％,(6.84±1.41)％、(6.91±1.31)％、(6.56±1.62)％],차이균유통계학의의,P＜0.05.이상술량개지표재VSD조여건강조지간균차이무통계학의의,P＞0.05.결론 주동맥축착교치술후환인잉존재혈관결구화내피공능이상,제시수술규치주동맥축착후혈관손해지속존재,가능시주동맥축착교치술후환인심혈관질병발생솔고우건강인동적원인.
Objective Even after successful surgical repair,patients with coarctation of the aorta (CoA) are at high risk of long-term morbidity and mortality due to cardiovascular events,which is probably related to persistent arterial disfunction during long-terr follow-up after operation,The aim of the study was to explore the alterations of vascular structure and function in children with successfully repaired CoA in the short-and mid-term follow-up.Methods A cohort of 20 children who underwent CoA repair between January 2010 and October 2010 in Guangzhou women and children's Medical Center was studied.There were 14 males and 6 females in CoA group,which comprised 6 patients with isolated CoA,14 patients with CoA associated with intracardia anomalies,whose median age of operation was 4 months (rang from lmonth to 10.0 years).And 20 patients with isolated ventricular septal defect (VSD) were included as VSD group during the same time,with 12 males and 8 females,whose median age of operation was 5 months (rang from 1 month to 12.0 years).Resting blood pressure,flow-mediated dilation (FMD) of the brachial artery,carotid intima-media thickness (IMT) were compared in CoA group and VSD group,including preoperative media data and follow-up of 1 month,6 months and 1 year.In addition,as comparison to the operation group,20 health children with normal echocardiographic findings,whose median age was 5 months (rang from 3 month to 10.0 years),were selected as health group for the 1-year following up.None of them had obesity,hyperlipidemia,diabetes mellitus,metabolic diseases or systemic inflammatory disease.Results As a result of the datas before operation and those I month,6 months and 1 year after operation,all children were normotensive at rest.In the same period,Carotid IMT in CoA group[(0.47 ± 0.10)mm,(0.49 ±0.10) mm,(0.57 ±0.07)mm,(0.61 ± 0.07) mm]was significantly thicker than that in VSD group[(0.41 ±0.11) mm,(0.43 ±0.11)mm,(0.51 ±0.08) mm,(0.55 ±0.08) mm](P＜0.05) and health group[(0.40 ±0.09) mm,(0.42 ±0.11)mm,(0.50 ±0.08) mm,(0.57 ±0.08) mm](P ＜0.05),Brachial artery FMI in children with CoA[(5.4,6 ±1.51)％,(5.71 ±1.88)％,(5.42±1.69)％,(5.27±1.02)％]was significantly lower than that in the VSD control group[(6.69±1.45) ％,(6.66±1.21)％,(6.81 ±1.03)％,(6.43±1.34)％](P＜0.05) and health group[(6.59 ±1.84)％,(6.84±1.41)％,(6.91 ±1.31)％,(6.56±1.62)％](P＜0.05).Significant difference could not be found in neither the IMT nor the FMI between the VSI control group and health group in 4 period respectively,P ＞ 0.05.Conclusion Children after successful coarctation repair have abnomal structural and functional properties of the aorta above the place of coarctation even their blood pressure at rest is normal.These results confirm that the alterations in mechanical properties of carotid arteries as well as the generalized endothelial dysfunction in children with coarctation of the aorta are persistent,which can not be prevented or reversed by surgical repair,and which may partly explain the high incidence of cardiovascular disease observed in their adulthood and reduced life expectancy,furtherly supporting the claim that coartation of the aorta is a systemic vascular disorder which needs long-term follow-up of vascular function.