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Percutaneous balloon angioplasty for native coarctation of the aorta
R H Beekman1, A P Rocchini, M Dick
1Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor 48109.
Insights
Percutaneous balloon angioplasty effectively reduced coarctation gradient in children. Long-term follow-up showed sustained gradient reduction and improved aortic pressure, indicating a beneficial treatment for coarctation of the aorta.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Coarctation of the aorta is a congenital narrowing of the aorta.
- Percutaneous balloon angioplasty is a minimally invasive treatment option.
- Assessing long-term outcomes of this procedure in children is crucial.
Purpose of the Study:
- To evaluate the acute and long-term efficacy of percutaneous balloon angioplasty for discrete native coarctation of the aorta in children.
- To identify factors associated with successful outcomes.
Main Methods:
- Twenty-six children underwent percutaneous balloon angioplasty for native coarctation.
- Acute procedural success was assessed by gradient reduction.
- Long-term outcomes were evaluated via follow-up catheterization (12-26 months).
Main Results:
- Angioplasty acutely reduced the mean systolic coarctation gradient by 75% (48.6 to 12.3 mm Hg).
- Long-term follow-up (14 children) showed a stable residual gradient (11.7 mm Hg) and improved ascending aorta systolic pressure.
- Two groups were identified: good outcome (residual gradient <20 mm Hg, no aneurysm) and poor outcome (residual gradient >20 mm Hg or aneurysm).
Conclusions:
- Percutaneous balloon angioplasty is effective in reducing coarctation gradients acutely and durably in children.
- Improved aortic pressure suggests significant hemodynamic benefit.
- Younger age and inappropriate balloon sizing may be associated with suboptimal outcomes.
Abstract:
Twenty-six children, aged 5 weeks to 14.7 years, underwent percutaneous balloon angioplasty for a discrete native coarctation of the aorta. The procedure reduced the systolic coarctation gradient acutely in all children. The mean systolic gradient decreased by 75%, from 48.6 +/- 2.4 before to 12.3 +/- 1.9 mm Hg after angioplasty (p less than 0.001). Long-term results were evaluated in 14 children by follow-up catheterization 12 to 26 months (mean 15.3) after angioplasty. At follow-up, the residual gradient averaged 11.7 +/- 3.7 mm Hg (range -5 to 36) and had not changed from that measured immediately after angioplasty (p = 0.64). Compared with preangioplasty values, the systolic pressure in the ascending aorta had improved substantially at follow-up (116.0 +/- 3.2 versus 143.9 +/- 3.1 mm Hg, p less than 0.001). On the basis of follow-up data, two groups of children were identified: Group 1 consisted of nine children with a good result, defined as a residual gradient less than 20 mm Hg and no aneurysm; Group 2 consisted of five children with a poor result, four with a residual gradient greater than 20 mm Hg (range 25 to 36) and one with an aneurysm at the dilation site. There was no statistical difference between the two groups in age at angioplasty, balloon size, ratio of balloon to isthmus diameters, follow-up duration, heart rate or cardiac output. However, of the four children with a residual gradient greater than 20 mm Hg, two were the youngest in the study, and in two the aorta was inadvertently dilated with a balloon 4 to 5 mm smaller than the isthmus diameter.(ABSTRACT TRUNCATED AT 250 WORDS)