[Balloon angioplasty for native coarctation in children: immediate and medium-term results]
María J del Cerro1, Aurora Fernández-Ruiz, Fernando Benito
1Servicio de Cardiología Pediátrica, Hospital Infantil La Paz, Madrid, Spain. mcerro.hulp@salud.madrid.org
Insights
Balloon angioplasty is effective for treating pediatric aortic coarctation. Improved techniques and patient selection in later years led to better success rates and fewer complications in treating this congenital heart defect.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Aortic coarctation is a congenital narrowing of the aorta.
- Balloon angioplasty is a debated treatment for native aortic coarctation in children.
- This study compares outcomes from two distinct treatment periods.
Purpose of the Study:
- To evaluate the effectiveness of balloon angioplasty for native aortic coarctation in pediatric patients.
- To compare immediate and medium-term results between two treatment eras.
- To identify factors influencing treatment success and complications.
Main Methods:
- Retrospective analysis of 53 pediatric patients with native aortic coarctation.
- Patients divided into two groups: 1985-1988 (Group A, n=26) and 1993-2003 (Group B, n=27).
- Comparison of immediate success rates, recoarctation rates, reintervention strategies, and complication incidence.
Main Results:
- Immediate success rates improved from 69.2% (Group A) to 81.5% (Group B).
- Recoarctation rates were similar (33% vs 25.6%), but reintervention strategies differed (surgery vs repeat angioplasty).
- Overall angioplasty success increased to 85% in Group B, with significantly lower complication (4% vs 19.2%) and aneurysm rates (4% vs 15%).
Conclusions:
- Balloon angioplasty is a viable alternative to surgery for select pediatric patients with native aortic coarctation.
- Improved patient selection, catheter technology, and care have enhanced outcomes.
- Repeat angioplasty for recoarctation improves overall success rates.
Introduction And Objectives:
The use of balloon angioplasty to treat native aortic coarctation in pediatric patients is controversial. Our aims were to report our experience with this technique and to compare retrospectively the immediate and medium-term results obtained during 2 distinct time periods.
Subjects And Method:
53 patients who underwent balloon angioplasty for native coarctation were divided into 2 groups: (A) those treated between 1985-1988 (n=26); and (B) those treated between 1993-2003 (n=27). Follow-up data were available for all patients.
Results:
The immediate result was good (i.e., pressure gradient, <20 mmHg) in 18/26 patients in group A (69.2%) and 22/27 (81.5%) in group B. On follow-up, the recoarctation rate was similar in both groups: 33% in group A and 25.6% in group B. Group A patients with recoarctation were referred for surgery, whereas group B patients underwent a second angioplasty (either balloon or stent). At the end of follow-up, angioplasty had been successful in 62% (16/26) of patients in group A vs 85% (23/27) in group B. The incidence of serious complications was lower in group B (4%) than group A (19.2%), as was the incidence of aneurysm: 4% in group B vs 15% in group A.
Conclusions:
Balloon angioplasty is an effective alternative to surgery for the treatment of native, localized aortic coarctation. Better selection of suitable patients, use of low-profile catheters, and improved patient care can reduce the incidence of complications. Repeat angioplasty (either balloon or stent) in cases of recoarctation has improved results with this technique.
