[Long-term outcomes of balloon angioplasty for aortic coarctation]
A N Korostelev1, L S Kokov, B B Cherniak
1Department of Cardiosurgery, A. V. Vishnevsky Institute of Surgery, Moscow, Russia.
Insights
Balloon angioplasty effectively treated discrete aortic coarctation in pediatric patients, showing good long-term outcomes in 79% of cases. Regular non-invasive monitoring is crucial for assessing patients post-procedure.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Context:
- Aortic coarctation is a congenital heart defect requiring intervention.
- Discrete coarctation presents specific challenges for treatment.
- Balloon angioplasty offers a minimally invasive therapeutic option.
Purpose:
- To evaluate the early and long-term outcomes of balloon angioplasty for discrete aortic coarctation.
- To assess the hemodynamic effectiveness and complication rates of the procedure.
- To determine the necessity of long-term non-invasive monitoring.
Summary:
- Balloon angioplasty was performed on 19 pediatric patients (ages 4-28) with discrete aortic coarctation between 1994-2001.
- Early results showed a 10 mm Hg decrease in systolic pressure gradient (SPG).
- Long-term follow-up (mean 3.0 years) demonstrated good outcomes in 79% of patients, with significant reductions in arterial pressure and SPG, and improved ankle-brachial index. Recoarctation occurred in 21% of cases, with some requiring surgical intervention. Aneurysmal dilatation, dissection, and iliac artery stenosis were noted in a small percentage of patients.
Impact:
- Balloon angioplasty provides a viable treatment for discrete aortic coarctation with favorable long-term results in a majority of pediatric patients.
- The study highlights the importance of regular non-invasive follow-up using methods like Doppler echocardiography, ultrasound, and CT angiography to monitor for recoarctation and other complications.
- This research contributes to understanding the long-term efficacy and potential risks associated with endovascular treatment of aortic coarctation in young individuals.
Abstract:
From 1994 to 2001 balloon angioplasty was fulfilled for 19 patients aged from 4 to 28 (mean 11.0+/-7.0) with discrete type aortic coarctation. Early outcomes were satisfactory in all cases. Catheterization showed 10 mm Hg decrease in systolic pressure gradient (SPG). Long-term results (from 6 months to 8 years, mean 3.0+/-2.5) were evaluated with transthoracic EchoCG, Doppler ultrasound, duplex scanning of iliofemoral segment and CT-angiography with 3D reconstruction. Surgical outcomes were considered good when SPG did not exceed 20 mm Hg for Doppler ultrasound and 25 mm Hg for Doppler EchoCG. In the study group there was statistically significant decrease in arterial pressure in right upper limb and SPG (measured with both Doppler EchoCG and Doppler ultrasonography) and rise of ankle-brachial index. Beneficial hemodynamic effect was detected in 15 from 19 patients (79%). Recoarctation has developed in 4 (21%) patients, in 1 (5.3%) case it was combined with true posttraumatic aortic aneurysm. Three patients underwent open surgical intervention with uneventful postoperative period. Aneurysmal dilatation of thoracic aorta has developed in 1 patient (5.3%), non-progressive intimal dissection - in another one (5.3%), 2 patients (10.5%) experienced ipsilateral 40-60% stenosis of right external iliac and femoral arteries. Thus good long-term outcomes of balloon angioplasty in patients with discrete type aortic coarctation were achieved in 79% cases. Patients after balloon angioplasty must be assessed regularly with non-invasive diagnostic methods such as Doppler ultrasonography, Doppler EchoCG, CT-angiography.
