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Balloon angioplasty of recurrent coarctation: a 12-year review
A T Yetman1, D Nykanen, B W McCrindle
1Department of Pediatrics, Hospital for Sick Children, University of Toronto School of Medicine, Ontario, Canada.
Insights
Balloon angioplasty offers long-term benefits for recurrent coarctation of the aorta. However, patients with transverse arch hypoplasia may require further surgical intervention.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pediatric Cardiology
Background:
- Balloon angioplasty is the standard treatment for recurrent aortic coarctation.
- Limited data exist on the long-term outcomes of this procedure in large patient cohorts.
Purpose of the Study:
- To investigate the long-term outcomes of balloon angioplasty for recurrent coarctation of the aorta.
- To identify predictors of reintervention in patients treated with balloon angioplasty.
Main Methods:
- Retrospective review of clinical, echocardiographic, hemodynamic, and angiographic data.
- Analysis of 90 consecutive patients undergoing balloon angioplasty between 1984 and 1996.
- Long-term follow-up assessment of reintervention rates.
Main Results:
- Balloon angioplasty significantly reduced pressure gradients and increased the diameter of the stenotic site.
- 88% of patients achieved optimal acute results (gradient < 20 mm Hg).
- 72% of patients with optimal early results remained free from reintervention at 12 years; transverse arch hypoplasia predicted reintervention.
Conclusions:
- Percutaneous balloon angioplasty provides long-term benefits for most patients with recurrent coarctation of the aorta.
- Transverse arch hypoplasia is a significant predictor for the need for reintervention.
- Further surgical intervention is often necessary for patients with transverse arch hypoplasia.
Objectives:
This study was undertaken to investigate the long-term outcome of balloon angioplasty for recurrent coarctation of the aorta in a large series of patients.
Background:
Balloon angioplasty has become the standard treatment for residual or recurrent aortic coarctation. Despite the widespread use of this treatment modality, there are few data outlining the long-term outcome of a large patient cohort.
Methods:
Clinical, echocardiographic, hemodynamic and angiographic data on 90 consecutive patients who underwent balloon angioplasty between January 1984 and January 1996 were reviewed.
Results:
Mean systolic pressure gradients were reduced from 31 +/- 21 to 8 +/- 9 mm Hg after dilation (p = 0.0001). The mean diameter of the stenotic site, measured in the frontal and lateral views, increased by 38% and 35%, respectively (p = 0.001). Neurologic events occurred in two patients, with one death. An aortic tear occurred in one patient, requiring surgical intervention. Optimal results were defined as a postprocedure gradient < 20 mm Hg and were obtained acutely in 88% of patients. At long-term follow-up (12 years), 53 (72%) of 74 patients with an early optimal result remained free from reintervention. Transverse arch hypoplasia, defined as an arch dimension < 2 SD below the mean for age, was the primary predictor of the need for reintervention.
Conclusions:
Although the majority of patients undergoing percutaneous balloon angioplasty for recoarctation of the aorta will achieve long-term benefit, the need for further surgical intervention in those with transverse arch hypoplasia remains high.