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Balloon angioplasty for coarctation of the aorta in infancy
Insights
Balloon angioplasty effectively treated coarctation of the aorta in infants, significantly reducing pressure gradients and increasing vessel diameter. This procedure is recommended over surgery for severe cases in neonates and young infants.
Area of Science:
- Cardiology
- Pediatric Surgery
- Interventional Cardiology
Background:
- Coarctation of the aorta is a severe congenital heart defect often requiring intervention in neonates and infants.
- Surgical repair in this age group is associated with high mortality and recurrence rates.
- Percutaneous balloon angioplasty offers a less invasive alternative.
Purpose of the Study:
- To evaluate the efficacy and safety of percutaneous balloon angioplasty for severe coarctation of the aorta in infants.
- To compare the outcomes of balloon angioplasty with traditional surgical methods.
Main Methods:
- Six infants with coarctation of the aorta and associated cardiac defects underwent balloon angioplasty.
- Catheters with 5-10 mm balloons were used, with pressure applied at 4-8 atm for 10-15 seconds, repeated at least three times.
- Hemodynamic parameters and anatomical measurements were assessed before and after the procedure.
Main Results:
- The mean systolic pressure gradient across the coarctation decreased significantly from 44.2 mmHg to 11.7 mmHg (P < 0.001).
- The diameter of the coarcted segment increased significantly from 2.9 mm to 6.3 mm (P < 0.001).
- Four out of six infants had excellent long-term results; two required further intervention.
Conclusions:
- Percutaneous balloon angioplasty is a safe and effective treatment for severe coarctation of the aorta in neonates and young infants.
- It leads to significant hemodynamic and anatomical improvements.
- Balloon angioplasty is recommended as the preferred therapeutic option over surgical repair for these patients.
Abstract:
Six infants with coarctation of the aorta underwent percutaneous balloon angioplasty over a 6-month period ending July 1985. These infants had associated cardiac defects including aortic stenosis, ventricular septal defect, and patent ductus arteriosus. Catheters used carried 5 to 10 mm balloons; 4 to 8 atm pressure was applied for 10 to 15 seconds, and the procedure was repeated at least three times. No significant complications were encountered during the procedure. The mean systolic pressure gradient across the coarctation decreased from 44.2 +/- 4.7 mm Hg to 11.7 +/- 9.4 mm Hg (P less than 0.001) after angioplasty, and the diameter of the coarcted segment increased from 2.9 +/- 0.7 mm to 6.3 +/- 1.2 (P less than 0.001). Long-term follow-up indicated excellent results in four patients; the other two infants required additional treatment (repeat angioplasty and surgical resection, respectively). No aneurysm was seen in any infant. Based on this experience and the reported high mortality and high recurrence rate after surgical repair in neonates and young infants, we recommend balloon angioplasty as the therapeutic procedure of choice for relief of severe, previously unoperated coarctation of the aorta in neonates and young infants.