Balloon dilation angioplasty of postoperative aortic obstructions

Balloon dilation angioplasty (BDA) was attempted 29 times in 27 patients, aged 3 months to 22 years, with postoperative aortic obstructions. Previous operations included end-to-end anastomosis (n = 10), subclavian flap angioplasty (n = 7) and patch angioplasty (n = 3) for aortic coarctation, end-to-end anastomosis for interrupted aortic arch type B (n = 4) and aortic arch reconstruction for hypoplastic left heart syndrome (n = 3). Two of the patients with interrupted arch had multiple areas of obstruction. Balloon sizes were between 2 and 6 times the diameter of the lesion and up to twice the diameter of the proximal transverse arch (mean 1.1). BDA was at least partially successful (more than 50% decrease in gradient and more than 30% increase in diameter) in 26 of the 29 procedures (90%). BDA failed in the 2 lesions with an initial diameter of more than 8 mm. No differences were apparent in the success rate among any of the clinical groups. Peak systolic gradient decreased from 42 +/- 14 to 14 +/- 15 mm Hg (p less than 0.01) and mean diameter increased from 4.1 +/- 2.6 to 6.8 +/- 3.2 mm (p less than 0.01). There was no mortality or significant acute morbidity associated with the procedure. After 1 to 24 months of follow-up, restenosis has occurred in only 1 patient. Aneurysm formation was found in 2 of 5 patients who had undergone repeat catheterization; both aneurysms occurred in patients with repaired interruption of the aortic arch.(ABSTRACT TRUNCATED AT 250 WORDS)