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Remodeling of the aorta after successful balloon coarctation angioplasty
1Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Insights
This study investigated aortic remodeling after balloon angioplasty for aortic coarctation. Successful angioplasty led to significant gradient reduction, with better aortic diameter standardization in patients with good outcomes.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Medical Imaging
Background:
- Aortic coarctation is a congenital heart defect requiring intervention.
- Balloon angioplasty is a treatment option for aortic coarctation.
- Aortic remodeling post-intervention requires further investigation.
Purpose of the Study:
- To determine if aortic remodeling occurs after successful balloon angioplasty of aortic coarctation.
- To compare aortic dimensions before and after angioplasty in pediatric patients.
Main Methods:
- Retrospective analysis of 30 children undergoing balloon angioplasty for aortic coarctation.
- Follow-up catheterization and angiography at 6-30 months.
- Measurement and standardization of aortic diameters at five sites in two views.
- Calculation of variance in standardized aortic measures to assess remodeling.
Main Results:
- Balloon angioplasty significantly reduced the mean coarctation gradient (44 to 10 mm Hg).
- Patients were categorized into good (Group A) and fair/poor (Group B) outcome groups based on gradient and recoarctation.
- Aortic diameter variance was similar before angioplasty but significantly different at follow-up (0.057 vs. 0.129, p=0.01), with greater improvement in Group A.
Conclusions:
- Successful balloon angioplasty for aortic coarctation leads to significant aortic remodeling.
- Aortic dimensions standardize more effectively in patients with good angioplasty outcomes.
- This suggests that angioplasty can positively influence aortic geometry in the long term.
Abstract:
The purpose of this study was to examine whether remodeling of the aorta takes place after successful balloon angioplasty of aortic coarctation. During the 35 month period ending in December 1987, 30 children, aged 14 days to 13 years, underwent balloon angioplasty of unoperated aortic coarctation, with a resultant reduction in mean coarctation gradient from 44 +/- 20 to 10 +/- 8 mm Hg (p less than 0.001). On the basis of results of 6 to 30 months' follow-up catheterization data in 20 children, the patients were classified into group A (13 patients with good results; gradient less than or equal to 20 mm Hg and no recoarctation on angiography) and group B (7 patients with fair or poor results; gradient greater than 20 mm Hg with or without recoarctation on angiography). Measurements of the aorta at five sites (the ascending aorta, isthmus, coarcted segment and descending aorta distal to the coarctation and at the level of the diaphragm) were made in two angiographic views, corrected for magnification and averaged. A standardized diameter of the aorta at the five locations was calculated for each case before angioplasty and at follow-up study, and variance of the diameter was then determined. The variance of standardized aortic measures (0.233 versus 0.287) was similar (p greater than 0.05) in both groups before angioplasty, whereas at follow-up study (0.057 versus 0.129) they were different (p = 0.01). There was a greater percent improvement at follow-up study (0.233 versus 0.057) in the group with good results than in the group with fair or poor results (0.287 versus 0.129).(ABSTRACT TRUNCATED AT 250 WORDS)