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Balloon dilation for aortic recoarctation: morphology at the site of dilation and long-term efficacy
1Department of Pediatric Cardiology, University Children's Hospital, Innsbruck, Austria. chrimann@vol.at
Insights
Balloon angioplasty effectively treats recurrent coarctation of the aorta, reducing pressure gradients and increasing vessel diameter. Long-term success depends on the diameter increase, with no observed aneurysm progression from vessel wall disruptions.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Coarctation of the aorta is a congenital heart defect requiring intervention.
- Recurrent or residual coarctation after initial surgery necessitates further treatment.
- Balloon angioplasty is a minimally invasive option for managing recoarctation.
Purpose of the Study:
- To evaluate the immediate and long-term outcomes of balloon angioplasty for recurrent coarctation.
- To assess the impact of balloon angioplasty on aortic vessel wall morphology.
- To identify predictors of success for this intervention.
Main Methods:
- Retrospective analysis of clinical, echocardiographic, angiographic, and hemodynamic data.
- Study included 71 patients treated between January 1987 and January 1998.
- Data collected before and after balloon angioplasty for recoarctation.
Main Results:
- Successful reduction in mean systolic pressure gradients (27 to 11 mmHg) and increase in mean diameter (5.5 to 7.5 mm).
- Immediate success rate of 71%, with 69% long-term success; age and diameter increase were key determinants.
- Vessel wall extravasations observed in 25% of immediate post-procedure angiograms, but did not progress to aneurysms.
Conclusions:
- Balloon angioplasty is a safe and effective treatment for recurrent coarctation of the aorta.
- The procedure leads to significant hemodynamic improvement and vessel dilation.
- Further advanced imaging may be needed to fully characterize vessel wall changes post-intervention.
Objectives:
We undertook this study to assess the immediate and long-term outcome of balloon angioplasty performed for recurrent or residual coarctation of the aorta, and to assess the changes in the vessel wall caused by this procedure.
Methods:
Clinical, echocardiographic, angiographic and hemodynamic data from 71 patients who underwent balloon angioplasty for recoarctation between January 1987 and January 1998 were analysed retrospectively.
Results:
Angioplasty was performed after a median of 82.6 months (range 1.4 mo-20.9 y, mean 88.5 mo) following surgery for coarctation. Mean systolic pressure gradients were reduced from 27 +/- 15 mmHg to 11 +/- 11 mmHg after angioplasty (p < 0.0001). The mean diameter at the site of recoarctation increased from 5.5 +/- 2.5 to 7.5 +/- 2.7 mm (p < 0.0001). Outpouchings of contrast agents, indicating the disruption of the inner layers of the vessel wall, were defined as extravasations. They were observed in one-quarter of the angiograms performed immediately after the intervention. Immediate success of angioplasty was achieved in 71%, and persisted in 69% of patients during long-term follow up. The main determinant for immediate success was the age at the time of the procedure (p < 0.05), while the main determinant for long-term success was the increase achieved in diameter. Extravasations did not progress to aneurysms, neither acutely nor during echocardiographic follow-up studies. For further follow-up, more sensitive imaging techniques will be necessary to delineate the morphology of the site of extravasation observed immediately after angioplasty.