Related Experiment Videos
[Short- and long-term problems in dilatation of untreated aortic isthmus stenosis in children]
O Galal1, B Gometza, Z al-Halees
1King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi-Arabien.
Insights
Balloon angioplasty for native coarctation of the aorta is a safe and effective treatment for children. While complications like arterial occlusion can occur, most patients experience successful outcomes with short hospital stays.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Interventional Radiology
Context:
- Coarctation of the aorta is a congenital narrowing of the aorta, often requiring intervention in pediatric patients.
- Balloon dilation offers a less invasive alternative to surgical repair for native coarctation.
- Assessing the safety and efficacy of balloon dilation in a pediatric cohort is crucial for treatment guidelines.
Purpose:
- To evaluate the problems and complications associated with balloon dilation of native coarctation of the aorta in children.
- To determine the success rate and long-term outcomes of this interventional procedure.
- To identify potential risks and adverse events during and after balloon angioplasty for pediatric coarctation.
Summary:
- This study analyzed 37 balloon dilation procedures in 31 children with native coarctation of the aorta.
- Complications included insufficient sedation (37.8%), femoral artery access issues (8.1%), and adverse events like blood loss (16.2%), chest pain (8.1%), balloon rupture (8.1%), and thrombectomy (8.1%).
- Follow-up revealed outcomes such as weak femoral pulses (21.6%) and paradoxical hypertension (21.6%), with balloon angioplasty concluding as a successful and relatively safe treatment, though arterial occlusion remains a serious concern.
Impact:
- Balloon angioplasty demonstrates significant success in treating native coarctation of the aorta in pediatric patients.
- The procedure is associated with a relatively low complication rate and short hospital stays, facilitating early discharge.
- Understanding potential complications, such as arterial occlusion, is vital for optimizing patient management and improving procedural safety.
Abstract:
We examined problems and complications during and after balloon dilation of native coarctation of the aorta in 31 children with a mean age at first dilation of 5.77 +/- 5.4 years (0.08-16 years), who had a total of 37 balloon dilations. Twenty-six patients were restudied 3 to 24 months after the first procedure. In six patients, because of recoarctation, further dilations were performed. In two patients the second procedure was not successful and they required surgery. In 14/37 (37.8%) dilations the routine sedation was insufficient. The retrograde catheter could be introduced percutaneously in all but one patient. Because of small femoral arteries the introduction of the balloon catheter was not possible in three cases (8.1%). In three more patients (8.1%) the adequate catheters were not in stock. Complications included: transfusion because of blood loss in six patients (16.2%), chest pain in three (8.1%), rupture of balloon in three (8.1%), thrombectomy in three (8.1%), and partial reopening of ductus arteriosus in one patient. Duration of hospital stay was a mean of 1.81 days +/- 1.65 (range 1-9 days). Ninety percent of the patients were discharged within 2 days. On follow-up (range: 3-50 months), eight patients (21.6%) had a weak femoral pulse, of whom only one had an absent pulse, eight patients (21.6%) had paradoxical hypertension despite good dilation and no significant gradients, and only one patient showed a small aneurysm. We conclude that balloon angioplasty of native coarctation is a successful and relatively safe method of treatment of native coarctation. The most serious complication is arterial occlusion of the affected leg.(ABSTRACT TRUNCATED AT 250 WORDS)