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Balloon dilatation of simple aortic coarctation in neonates and infants
S S Kothari1, R Juneja, A Saxena
1Department of Cardiology, All India Institute of Medical Sciences, New Delhi.
Insights
Balloon dilatation is effective for infant coarctation of the aorta, especially in infants older than three months. Infants under three months experience rapid restenosis despite initial improvement in left ventricular function.
Area of Science:
- Pediatric Cardiology
- Interventional Cardiology
- Congenital Heart Disease
Background:
- Coarctation of the aorta is a critical congenital heart defect requiring timely intervention.
- Balloon dilatation is a therapeutic option for native coarctation in infants.
Purpose of the Study:
- To evaluate the safety and efficacy of balloon dilatation for isolated native coarctation of the aorta in infants.
- To compare outcomes between infants younger and older than three months.
Main Methods:
- Retrospective analysis of 21 infants undergoing balloon dilatation for coarctation of the aorta.
- Assessment of procedural success, hemodynamic changes, and long-term outcomes including restenosis.
Main Results:
- Successful relief of coarctation was achieved in 71% of infants up to three months and 86% of older infants.
- Left ventricular function improved in all infants with depressed ejection fraction.
- Restenosis occurred in all infants under three months, and in 3 of 11 older infants.
Conclusions:
- Balloon dilatation is safe and effective for infants older than three months with native coarctation of the aorta.
- While feasible and improving ventricular function in younger infants, rapid restenosis limits long-term success in this group.
Abstract:
Twenty-one infants with isolated native coarctation of aorta (mean age 4.73 +/- 2.85 months, range 15 days-12 months) underwent balloon dilatation in the last seven years at our institute. Seven of them were less than three months and 14 were older than three months. The procedure was successful in relieving the coarctation (gradient < 20 mm Hg) in five of seven (71%) infants up to three months and 12 of 14 (86%) above three months. Peak systolic gradients decreased from 70.8 +/- 20.1 to 14.5 +/- 11 mm Hg in the younger infants and from 47.7 +/- 11.7 to 11.4 +/- 9.9 mm Hg in infants above three months. Post-dilatation angiogram showed the coarctation segment to be equal to the isthmus in both the groups, 0.96 +/- 0.14 and 0.96 +/- 0.12 respectively. One three months old infant died immediately after a successful dilatation possibly due to coronary embolism, and another neonate died a few days later of unrelated pre-existing septicemia. Left ventricular function improved in all the infants with depressed preprocedure ejection fraction. Restenosis defined as peak instantaneous echo-Doppler gradient above 20 mm Hg with a significant narrowing on two-dimensional echocardiography occurred in all the five infants up to three months over a period of 1 to 12 months. Follow-up information over a period of 4 to 24 months was available in 11 of 14 older infants of which three had restenosis. Gradients progressively increased in all the four infants (2 of either group) with an initial partially successful result. A small isthmus relative to the descending thoracic aorta at diaphragm is an important predictor of restenosis/inadequate result. This discrepancy was seen much more in smaller infants, post-dilatation coarctation index being 0.68 +/- 0.11 vs 0.81 +/- 0.16 (p = 0.07). Four of the infants underwent a repeat successful dilatation. Balloon dilatation is safe and effective in infants above three months of age. In infants up to three months the procedure is feasible and leads to improvement in left ventricular function, but restenosis occurs rapidly in all of them.