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[Percutaneous transluminal angioplasty with a balloon catheter in native aortic coarctation: long-term experience]
J M Palacios Rodríguez1, F Puente, A Dávila
1Departamento de Cardiología y Hemodinamia, Hospital No. 25 del I.M.S.S., Centro Médico Nacional Monterrey, N.L.
Insights
Transluminal percutaneous balloon angioplasty effectively treated aortic coarctation in 19 patients, significantly reducing systolic pressure gradients and blood pressure. Follow-up confirmed sustained improvements and no complications, with most patients maintaining normal blood pressure without medication.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Pediatric Cardiology
Context:
- Aortic coarctation is a congenital heart defect characterized by narrowing of the aorta.
- Native aortic coarctation presents significant challenges in management, often leading to hypertension.
- Traditional surgical repair can be invasive; minimally invasive options are sought.
Purpose:
- To evaluate the efficacy and safety of transluminal percutaneous balloon angioplasty (PTBA) for native aortic coarctation.
- To assess the impact of PTBA on systolic pressure gradients and blood pressure control.
- To determine the long-term outcomes and complication rates associated with PTBA in this patient cohort.
Summary:
- Nineteen patients with native aortic coarctation underwent PTBA using balloon catheters (15-20 mm).
- The procedure, performed under local anesthesia, resulted in a significant reduction of systolic pressure gradients from 77 mmHg to 5.0 mmHg.
- Post-procedure, blood pressure decreased from 190/-- mmHg to 130/-- mmHg, and aortic ring diameter increased from 4.2 mm to 14.1 mm.
- Follow-up at 24.7 months showed sustained low pressure gradients (5 mmHg) and increased diameter (15.4 mm) without aneurysms.
- Seventeen patients achieved normal blood pressure post-treatment, with only two requiring minimal antihypertensive medication.
Impact:
- PTBA offers a safe and effective minimally invasive alternative for treating native aortic coarctation.
- Successful angioplasty leads to significant and durable reduction in blood pressure and hypertension.
- This technique improves aortic lumen diameter, potentially preventing long-term cardiovascular complications.
Abstract:
Between August 1988 and October 1993, 19 patients with native aortic coarctation were subjected to transluminal percutaneous balloon angioplasty, 12 of which were men (63.1%) and 7 were women (36.9%), with an average age of 22 +/- 7.7 years (r- 16 to 52), all of whom suffered from arterial hypertension at the time of the procedure, and a systolic pressure of 190 +/- 32.2 mmHg (r- 160 to 240). The gradient of the systolic pressure (GPS) was 77 +/- 0.9 mm, the average diameter of the balloon catheters that were used was 18.3 +/- 1.7 mm (r- 15 to 20). For all the patients, the procedure was carried out under local anesthesia and the usual Seldinger technique. After carrying out the procedure, the GPS as well as the blood pressure dropped to 5.0 +/- 4.1 mmHg and 130 +/- 20.6 mmHg, respectively. In similar manner, the enlargement of the ring displayed an increase of 4.2 +/- 0.9 to 14.1 +/- 1.6 mm. There were no complications in any of the procedures. During the follow-up, 11 patients were catheterized again in a period of 24.7 +/- 12.6 months (r- 10 to 48) with GPS of 5 +/- 2 mmHg. Besides, an increase of 15.4 +/- 1.2 mm in the ring's diameter was observed. In these patients, there was no evidence of the aneurysms at the dilatation site. Of the rest of the patients under control, 17 of whom have been able to maintain normal blood pressure without medical treatment, and only two required low dosages of antihypertensive treatment.(ABSTRACT TRUNCATED AT 250 WORDS)