Circulation, Vol 84, 1150-1156, Copyright © 1991 by American Heart Association
ZM Hijazi, JT Fahey, CS Kleinman and WE Hellenbrand
BACKGROUND. As angioplasty techniques have been refined and larger low-
profile balloons developed, a nonsurgical approach to recoarctation has
become available. Several reports have documented both the efficacy and
safety of this procedure. However, there are little data available on the
long-term follow-up of these patients. This report details the initial
results and long-term evaluation of both the relief of obstruction and the
presence of hypertension after balloon angioplasty for recurrent
coarctation. METHODS AND RESULTS. Balloon angioplasty for recurrent
coarctation of the aorta was performed 29 times in 26 patients at a median
age of 4 years and 9 months (range, 4 months to 29 years), with eight
patients less than 1 year old. Initial surgical techniques were end-to-end
anastomosis in 11 patients, subclavian flap aortoplasty in 11 patients, and
patch aortoplasty in four patients. Angioplasty was performed at a median
interval of 2 years and 7 months (range, 4 months to 23 years) after
surgery. Mean peak systolic pressure difference across the coarctation
decreased from 40.0 +/- 16.8 to 10.3 +/- 9.5 mm Hg (p less than 0.05) after
the initial angioplasty, and mean diameter of the aortic lumen at the
coarctation site increased from 5.8 +/- 3.5 to 9.0 +/- 4.3 mm (p less than
0.05). There was no mortality, and only one patient developed an aneurysm
(4%). Three patients underwent repeat angioplasty for a pressure difference
of more than 20 mm Hg. Long-term follow-up is available on 24 of 26
patients with a mean follow-up of 42 +/- 24 months (range, 12-88 months).
Mean peak systolic pressure difference across the area of coarctation
decreased from 40.3 +/- 17.4 before angioplasty to 8.5 +/- 8.3 mm Hg after
final angioplasty (p less than 0.05) and 7.5 +/- 7.5 mm Hg at follow-up.
Mean peak systolic blood pressure in the upper extremities decreased from
133.1 +/- 14.9 before angioplasty to 111.1 +/- 14.1 mm Hg at long-term
follow-up (p less than 0.05). CONCLUSIONS. Balloon angioplasty should be
considered the treatment of choice for relief of recurrent aortic
coarctation.
ARTICLES
Balloon angioplasty for recurrent coarctation of aorta. Immediate and long-term results
Department of Pediatrics and Pediatric Cardiology, Yale University School of Medicine, New Haven, Conn. 06510.
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