Balloon Angioplasty for Native Aortic Coarctation in 3- to 12-Month-Old Infants
Juan Pablo Sandoval1, Sok-Leng Kang1, Kyong-Jin Lee1
1Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, The Labatt Family Heart Centre, University of Toronto School of Medicine, Canada.
Insights
Balloon angioplasty is effective for infants aged 3-12 months with coarctation of the aorta (CoA). This treatment offers outcomes comparable to older patients, with reinterventions often avoiding surgery.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
Background:
- Coarctation of the aorta (CoA) treatment via balloon angioplasty is effective in children and adults.
- Neonatal balloon angioplasty for CoA frequently results in restenosis.
- The efficacy of balloon angioplasty for native CoA in infants beyond the neonatal period (3-12 months) was investigated.
Purpose of the Study:
- To examine the efficacy and safety of balloon angioplasty for native coarctation of the aorta (CoA) in infants aged 3 to 12 months.
- To compare outcomes in this age group to those in neonates, older children, and adults.
Main Methods:
- Retrospective review of 68 infants who underwent balloon angioplasty for native CoA.
- Analysis of procedural data, including age, weight, blood pressure gradients, and CoA diameter.
- Assessment of reintervention rates (catheter or surgical) and long-term complications such as thrombosis and aneurysms.
Main Results:
- Balloon angioplasty significantly reduced both noninvasive (41.2 to 5.6 mm Hg) and invasive (34 to 11 mm Hg) pressure gradients.
- CoA diameter increased from 2.7 mm to 4.6 mm post-procedure.
- Freedom from reintervention was 89% at 1 year, 83% at 5 years, and 81% at 10 years. Reintervention was needed in 11.8% and surgery in 10.3% of patients. Femoral artery thrombosis occurred in 9% without long-term issues; one patient developed a small aortic aneurysm.
Conclusions:
- Balloon angioplasty is an effective and safe treatment for native coarctation of the aorta (CoA) in infants aged 3 to 12 months.
- Outcomes in this infant group are comparable to those observed in older children and adults.
- Catheter reinterventions successfully avoided surgery in the majority of patients requiring further intervention.
Background:
Balloon angioplasty for native coarctation of the aorta (CoA) is successful in children and adults but in neonates results in frequent restenosis. The efficacy of balloon angioplasty for native CoA during infancy beyond the neonatal period was examined in infants aged 3 to 12 months of age.
Methods:
A retrospective review of 68 infants who underwent balloon angioplasty for native CoA. 95% CI are in parentheses.
Results:
Procedural age was (mean±SD) 6±3.4 months and weight was 7±1.8 kg. Balloon angioplasty produced a large decrease in both the noninvasive arm-to-leg blood pressure gradient (41.2±18.7 to 5.6±9.6 mm Hg) and the invasive peak systolic pressure gradient (34±12 to 11±9 mm Hg). Balloon angioplasty increased the CoA diameter from 2.7±1 mm to 4.6±1.2 mm. One patient was lost to follow-up. A catheter reintervention was required in 11.8% and surgery in 10.3%. The hazard of reintervention was highest early. Median freedom from reintervention was 89% (95% CI, 80%-96%) at 1 year, 83% (95% CI, 73%-92%) at 5 years, and 81% (95% CI, 69%-90%) at 10 years. Femoral artery thrombosis was documented in 6 (9%) infants without any long-term consequence. One patient developed a small aortic aneurysm late and has not required treatment. A robust estimate of the frequency of aortic aneurysms remains to be determined as the majority of subjects have not had cross-sectional imaging.
Conclusions:
Balloon angioplasty of native CoA is effective and safe in infants aged 3 to 12 months with outcomes comparable to those in older children and adults. Catheter reinterventions can avoid the need for surgery in most patients.
