Balloon Angioplasty for Native Coarctation of the Aorta: Acute and Mid-Term Results
1Division of Pediatric Cardiology, Department of Pediatrics, Tufts-New England Medical Center, Box 313, 750 Washington Street, Boston, MA, 02111, USA.
Insights
Balloon angioplasty effectively treats native coarctation of the aorta in children, including infants. This procedure safely reduces pressure gradients and improves vessel diameter, with repeat dilation and surgical repair being viable options.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Balloon angioplasty is a standard treatment for recurrent coarctation of the aorta.
- Its use in native coarctation, especially in infants, remains debated.
Purpose of the Study:
- To evaluate the immediate and mid-term outcomes of balloon angioplasty for native coarctation.
- To include outcomes in infants under 6 months of age.
Main Methods:
- Twenty-four children with native coarctation underwent balloon angioplasty.
- Data collected included age, weight, pressure gradients, and vessel diameter before and after the procedure.
Main Results:
- Mean peak systolic gradient decreased significantly (40 to 9 mmHg).
- Mean diameter of the coarctation improved (4.1 to 7.5 mm).
- Recurrence occurred in 4 patients (3 infants <3 months), with 2 successfully redilated. One patient developed an aneurysm.
Conclusions:
- Balloon angioplasty is a safe and effective treatment for most native coarctation cases.
- Repeat dilation is feasible, and surgical aneurysm repair is safe.
Abstract:
BACKGROUND: Balloon angioplasty is an accepted treatment for recurrent coarctation of the aorta. Application of this technique to patients with native coarctation is controversial. OBJECTIVE: To report on the immediate and mid-term results of this procedure in patients with native coarctation, including infants <6 months of age. METHODS AND RESULTS: Twenty-four children underwent balloon angioplasty of their coarctation at a median age of 2 yr. (range 2 weeksÐ14.7 yr.) and median weight of 13 kg (range 3Ð64 kg). The mean peak systolic gradient across the coarctation decreased from 40 +/- 14 to 9 +/- 6 mmHg (p < 0.001) and the mean diameter of the narrowest area improved from 4.1 +/- 2.1 to 7.5 +/- 2.5 mm (p < 0.001). Four patients had recurrence of their coarctation, 3 of whom were < 3 months of age. Two of these patients had successful repeat dilation. At a mean follow-up interval of 2.4 +/- 1.7 years, one patient (4%) developed an aneurysm. Three patients underwent surgical repair (two for recurrence and one for resection of the aneurysm). The remaining patients (87.5%) are normotensive with mean peak systolic gradient between the right arm and the lower extremity of 4 +/- 9 mmHg. CONCLUSION: Balloon angioplasty for native coarctation is an effective and safe method for most patients with coarctation. Repeat dilation is possible and surgical repair of an aneurysm is safe.
