编者按：儿童主动脉疾病在幼儿时期可能无明显症状，如何早期识别和有效干预成为临床关注的重点。在第二十六届长城国际心脏病学会议现场，《国际循环》编辑部采访到美国埃默里大学儿科教授William Mahle，请他介绍儿童主动脉疾病早期诊断和干预的是与非。

　　International Cirulation：The diagnosis and treatment of aortic diseases in children is already causing more and more attention. So， how can we achieve the goal of early diagnose and early intervention， and what is the key point?

　　早期诊断和干预是关键

　　William Mahle: So， in neutral diagnosis before the baby was born can be very very helpful to avoid problem. Fortunately， the echo cardiacgraphics?in China have each year more understanding of this condition， and seem to be able to find many of this kind of children before birth. If not， usually the babies have heart murmur right after birth， and PD attrition（PDA） when listen to the baby and usually identify within just couple hours before the babies born.

　　And some babies as we called “critical aortic stenosis”， that means unless we give the medicine and keep opening one of the blood vessels， the doctorsaysaorta，  they are likely to get very sick in the first days of life. So it is important to figure out which babies have critical aortic stenosis， because we are going to do something before the one month of age.

　　在患儿出生前进行诊断对避免各种问题有很大帮助。目前中国超声心动图 <http://baike.baidu.com/view/127227.htm>检查进展迅速，可在婴儿出生前诊断出此类疾病。诊断要点为患儿在出生前有心脏杂音，且在出生前几个小时可用听诊判断是否存在动脉导管未闭现象。

　　有些婴儿患有所谓“急性主动脉狭窄”，意味着必须使用药物保持主动脉血管扩张，否则婴儿在出生的前几天都会非常虚弱。所以及时识别急性主动脉狭窄非常重要，可帮助医生把握时机在患儿出生后一个月内实施治疗。

　　International Circulation: And about the management strategies of this disease， what do you recommend us to insist on?

　　应坚持的处理原则

　　WM: So this is one of the most challenging issues for us to tackle in PDA cardiology. Fortunately， about 3 years ago， doctor start using balloons to open the aorta up and work out， and we thought that we will be able to treat newly of thechildren. However it turnout that it is not that easy: in some cases， the balloon will have to tear it out， and it tears for about weeks. So some children may have balloon early on， and then be worse because of this for weeks. Because of that， some surgeons now say we should do surgery to fix that out rather than balloon. So in many parts of the world there is controversy， as to what is the best way to treat these children， we don’t know the answer just yet， neither surgery nor balloon is perfect. Lastly， it is important point out that sometimes when the problems are already out， there are also problems of the other parts of heart. The last ventricle may be too small， or may not be squeezed well. So sometimes you can make this work out better， but the child suffers from that for weeks in their heart. In the United States， we might do now an operation called “Norwegian Procedure”， that basically does without the left heart， but that is very challenging and is not done throughout the world.

　　There are also other surgery options that I talked about， and I talked about using the balloon to open the aorta up. Some people even use balloon to open the aorta out before birth in very small number of children; we are not sure how well that will works out， and we are still looking into that information. And today， only a very small number of children on the world have balloon dilation in the aorta before they born.

　　心脏动脉导管未闭是临床最大的挑战之一。3年前，医生们开始采用球囊扩张血管成形术，当时该项技术被认为很有效。然而事实并非如此：患儿治疗伊始有所获益，但有时球囊会破裂并持续几周不被发现，患儿因此病情加重。最近，球囊扩张还会引起心脏其他方面的问题，如血管太窄，或球囊支撑不到位等。因此，有些外科医生们认为外科手术比球囊更安全。截至目前，用哪种方法治疗更有效在全球范围内仍存争议。

　　甚至有人对一小部分出生前婴儿用球囊扩张血管成形术。这种方法是否有效尚未可知，还需进一步研究数据。

　　International Circulation: So， as the interventional treatment of aortic disease in children， does it have very progressive future?

　　未来治疗方法发展前景

　　WM: So， we tell families that it is really life-saving. But many babies who have an interventional in the first month of life will likely need something else in their life. So it is not like that we can fix the problem， we just do the first part of several attempts to help that out. Sometimes we open up the bell with the balloon， and child goes Hong Kong in the hospital; but they did all leakage complications later， and maybe in later life they need heart operations to replace the aorta out. That may not be the best， but it does give child a chance of survival. So we always have to adjust the parents’ expectations that we cannot make it perfect， but we can make the baby survive.

　　早期手术可能挽救患儿生命，但出生前患儿手术还需具备其他指征。球囊扩张并不能彻底治愈主动脉疾病，只在疾病早期做了现有医疗力所能及的帮助。有些患儿如后期发生并发症，可能要进一步手术替换整个动脉。所以球囊扩张虽然可能不是最佳方案，但至少增加了患儿生存的概率。