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[Percutaneous transluminal angioplasty in aortic coarctation. The short- and median-term results]
M Ledesma Velasco1, J L Acosta Valdes, J Munayer Calderón
1Departamento de Hemodinamia y Fisiología Pulmonar, Hospital General Centro Médico la Raza, México, D.F.
Insights
Percutaneous transluminal angioplasty (PTA) effectively treats aortic coarctation (Ao Co), reducing pressure gradients and improving anatomy. Outcomes vary based on aortic arch hypoplasia severity.
Area of Science:
- Cardiovascular Interventions
- Pediatric Cardiology
- Interventional Radiology
Background:
- Aortic coarctation (Ao Co) is a congenital heart defect requiring effective treatment.
- Percutaneous transluminal angioplasty (PTA) offers a less invasive alternative to surgery for Ao Co.
Purpose of the Study:
- To evaluate the efficacy and safety of PTA in patients with native and post-surgical Ao Co.
- To assess the impact of aortic arch hypoplasia on PTA outcomes.
Main Methods:
- PTA was performed in 34 patients with Ao Co using single or dual balloon techniques.
- Patients were stratified into three groups based on aortic arch hypoplasia severity.
- Outcomes were assessed by gradient reduction and angiographic improvement during follow-up.
Main Results:
- Significant gradient reduction and angiographic improvement were observed across all groups.
- Group III (no hypoplasia) showed the best results (71% gradient drop, 60% improvement).
- Complications included cerebral hemorrhage, embolism, thrombosis, and aneurysm, with one death.
Conclusions:
- PTA is a viable treatment option for Ao Co with lower morbidity and mortality than surgery.
- Treatment success is significantly influenced by the anatomical type of coarctation and degree of aortic arch hypoplasia.
Abstract:
Percutaneous transluminal angioplasty (PTA) was performed in 34 patients with aortic coarctation (Ao Co). One of them with coarctation after surgical correction, the rest were native Ao Co. We used one balloon in 28 patients and two balloons simultaneously in 6. They were separated in three groups according to the degree of aortic arc hypoplasia. Group I (mild to moderate hypoplasia N = 9) the gradient dropped 39% with angiographic improvement of 48% during the follow-up (m = 13.1 months). Three cases with restenosis, 2 were satisfactory dilated and one was sent to surgery. In Group II (severe hypoplasia N = 4) the gradient dropped 31% with angiographic improvement of 30% (follow-up 16.3 months). Two cases with recoarctation were sent to surgery. In Group III (without hypoplasia N = 21) we obtained dropped of gradient of 71% with angiographic improvement of 60% (follow-up 18.5 months). Two cases were redilated successfully. The complications were: cerebral hemorrhage with death due to hypertensive crisis, (1) cerebral embolism, (1) thrombosis in the puncture site 1 and small aneurysm in dilated zone. (1) We think PTA is a good choice to conventional surgery with low rate of morbidity-mortality. The results depend basically on the anatomic type of coarctation and degree of aortic arch hypoplasia.