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Percutaneous balloon coarctation angioplasty: long-term results
1University of Missouri--Columbia 65212.
Insights
Percutaneous balloon angioplasty effectively reduces systolic gradient in patients with coarctation of the aorta. Long-term follow-up shows good results for most patients, with some infants requiring repeat procedures.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Coarctation of the aorta is a congenital heart defect requiring intervention.
- Percutaneous balloon angioplasty is a treatment option for coarctation of the aorta.
Purpose of the Study:
- To evaluate the long-term efficacy and safety of percutaneous balloon angioplasty for discrete coarctation of the aorta.
- To assess outcomes based on patient age and coarctation type.
Main Methods:
- Retrospective analysis of 118 percutaneous balloon angioplasty procedures in 110 patients (2 days to 35 years).
- Pre- and post-procedure gradient measurements.
- Long-term follow-up using catheterization and Doppler echocardiography (1-9 years).
- Patient stratification into four groups based on age and coarctation characteristics.
Main Results:
- Significant reduction in mean systolic gradient from 48 +/- 22 to 8 +/- 7 mmHg post-angioplasty (P < 0.0001).
- Mean residual gradient of 9 +/- 8 mmHg at long-term follow-up.
- Good outcomes with no re-intervention needed for older patients (Groups I & II).
- Infants (Group III) required redilatation or surgery, with no procedure-related mortalities.
Conclusions:
- Percutaneous balloon angioplasty is a safe and effective treatment for discrete coarctation of the aorta.
- Outcomes vary by age, with infants requiring closer monitoring and potential repeat interventions.
- Long-term results are favorable, with minimal residual gradients and no procedure-related deaths.
Abstract:
One hundred and ten patients, age 2 days to 35 years (mean 7.0 +/- 7.0 years), have undergone 118 percutaneous balloon angioplasty procedures for discrete coarctation of the aorta since April 1982. The mean systolic gradient was significantly decreased from 48 +/- 22 to 8 +/- 7 mmHg after angioplasty (P less than 0.0001). Long-term results were evaluated in 95 patients, by follow-up catheterization in 30 and Doppler echocardiography in 65 patients. The follow-up period was 1-9 years (4.2 +/- 2.1). At follow-up the mean residual gradient was 9 +/- 8 mmHg. On the basis of follow-up data, four groups of patients were identified: group I consisted of 53 patients over 3 months of age with native coarctation of the aorta; group II consisted of 13 patients with postoperative coarctation restenosis; group III consisted of 21 infants 3 months of age or younger with native coarctation of the aorta; and group IV consisted of eight infants who developed postdilatation restenosis. Patients in groups I and II had good results and required no redilatation or surgical repair. In group III successful redilatation in eight and surgical repair in seven infants were performed 1 month to 5 years after the initial dilatation. There were no mortalities related to the 118 dilatation procedures. Of the seven patients who had surgical repair of the coarctation and the associated cardiac anomalies, four expired in the immediate postoperative period.(ABSTRACT TRUNCATED AT 250 WORDS)