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percutaneous balloon angioplasty for Severe Native Aortic Coarctation in Young Infants Less Than 6 Months： Medium- to Long-term Follow-up

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Chinese Medical Journal 2015年第8期128卷 1021-1025页

作者： Lan He Fang Liu Lin Wu Chun-Hua Qi Li-Feng Zhang Guo-Ying Huang Pediatric Heart Center Children's Hospital of Fudan University Shanghai 201102 China

Background： Although balloon angioplasty （BA） has been performed for more than 20 years, its use as a treatment for native coarctation of the aorta （CoA） during childhood, especially in young infants, remains controversial. This study aimed to assess the effects and potential role ofpercutaneous transcatheter BA for native CoA as an alternative therapy to surgical repair in young infants. Methods： The 37 patients aged from 6 days to 6 months with severe CoA in congestive heart failure or circulatory shock were admitted for BA. Patient＇s weight ranged from 2.4 to 6.1 kg. All 37 patients were experiencing cardiac dysfunction, and eight patients were in cardiac shock with severe metabolic acidosis. Eleven patients had an isolated CoA, whereas the others had a CoA associated with other cardiac malformations. Cardiac catheterization and aortic angiography were performed under general anesthesia with intubation. Transfemoral arterial approaches were used for the BA. The size of the balloon ranged from 3 mm × 20 mm to 8 mm × 20 mm, and a coronary artery balloon catheter was preferred over a regular peripheral vascular balloon catheter. Results： The femoral artery was successfully punctured in all but one patient, with that patient undergoing a carotid artery puncture. The systolic peak pressure gradient （PG） across the coarctation was 41.0 ± 16.0 mmHg （range 13-76 mmHg）. The mean diameter of the narrowest coarctation site was 1.7 ± 0.6 mm （range 0.5-2.8 mm）. All patients had successful dilation; the PG significantly decreased to 13.0 ± 11.0 mmHg （range 0-40 mmHg）, and the diameter ofcoarctation significantly improved to 3.8 ± 0.9 mm （range 2.5-5.3 mm）. No intraoperative complications occurred for any patients. However, in one case that underwent a carotid artery puncture, a giant aneurysm formed at the puncture site and required surgical repair. The following observations were made during the follow-up period from 6-month to 7-year：（1） The PG across the coarctation measur

关键词： Native Aortic Coarctation percutaneous balloon angioplasty Young Infants

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Hepatic venous outflow obstruction after piggyback liver transplantation by an unusual mechanism:Report of a case

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World Journal of Gastroenterology 2006年第33期12卷 5416-5418页

作者： Simon Siu-Man Ng Simon Chun-Ho Yu Janet Fung-Yee Lee Paul Bo-San Lai Wan-Yee Lau Departments of Surgery and Diagnostic Radiology & Organ Imaging Chinese University of Hong Kong Prince of Wales Hospital Shatin Hong Kong China

Hepatic venous outflow obstruction after piggyback liver transplantation is a very rare complication. An unusual mechanism aggravating it is reported. A 33-year-old man with end-stage hepatitis B liver cirrhosis underwent a piggyback orthotopic liver transplantation using a full-size cadaveric graft. Two months after transplantation, he developed gross ascites refractory to maximal diuretic therapy. Doppler ultrasound showed patent portal and hepatic veins. Serial computed tomography scans revealed a hypoperfused right posterior segment of the liver which subsequently underwent atrophy. Hepatic venography demonstrated a high-grade stenosis with an element of torsion of venous drainage at the anastomosis. The stenosis was successfully treated with repeated percutaneous balloon angioplasty. The patient remained asymptomatic six months afterwards with complete resolution of ascites and peripheral edema. We postulate that liver allograft segmental hypoperfusion and atrophy may aggravate or result in a hepatic venous outflow problem by the mechanism of torsion effect. percutaneous balloon angioplasty is a safe and effective treatment modality for anastomotic stenosis.

关键词： Hepatic venous outflow obstruction Piggyback Liver transplantation percutaneous balloon angioplasty

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