Circulation, Vol 87, 793-799, Copyright © 1993 by American Heart Association
RE Shaddy, MM Boucek, JE Sturtevant, HD Ruttenberg, RB Jaffe, LY Tani, VE Judd, LG Veasy, EC McGough and GS Orsmond
BACKGROUND. The use of balloon coarctation angioplasty instead of surgery
as treatment for unoperated coarctation of the aorta is controversial. The
efficacy and complications of the two procedures have not been studied
before in a prospective fashion. METHODS AND RESULTS. Thirty-six patients
were prospectively randomized to either angioplasty (20 patients) or
surgery (16 patients). Immediate results and patient follow-up, including
physical examination, angiograms, and magnetic resonance imaging, were
compared between groups. Reduction in peak systolic pressure gradient
across the coarctation was similar (86%) immediately after both balloon
coarctation angioplasty and surgery. On follow-up, aneurysms were seen only
in the angioplasty group (20%) and not in the surgery group (0%). No
aneurysms have shown progression or required surgery. The incidence of
other complications was similar in both groups, although two patients
experienced neurological complications after surgery. Although not
statistically different, the incidence of restenosis (peak systolic
pressure gradient > or = 20 mm Hg) tended to be greater in the
angioplasty group (25%) than in the surgery group (6%). Restenosis after
angioplasty occurred more frequently in patients with an aortic
isthmus/descending aorta diameter ratio < 0.65 and was associated with
an immediate catheterization residual peak systolic pressure gradient
across the coarctation > or = 12 mm Hg. CONCLUSIONS. Immediate gradient
reduction is similar after balloon coarctation angioplasty and surgical
treatment of unoperated coarctation of the aorta. The risks of aneurysm
formation and possibly restenosis after angioplasty are higher than after
surgery, although the risks of other complications are similar. Balloon
coarctation angioplasty may provide an effective initial alternative to
surgical repair of unoperated coarctation of the aorta in children beyond
infancy, particularly in patients with a well-developed isthmus. Further
follow-up is necessary to determine the long-term risks of postangioplasty
aneurysms.
ARTICLES
Comparison of angioplasty and surgery for unoperated coarctation of the aorta
Department of Pediatrics, University of Utah Medical Center, Salt Lake City.
This article has been cited by other articles:
 |
|
 |
|
  M. M. IJland and R. B. Tanke Aortic Coarctation Circulation, September 29, 2009; 120(13): 1294 - 1295. [Full Text] [PDF]
|
|
|
|
 |
|
 U. R. Mohan, S. Danon, D. Levi, D. Connolly, and J. W. Moore Stent Implantation for Coarctation of the Aorta in Children <30 kg J. Am. Coll. Cardiol. Intv., September 1, 2009; 2(9): 877 - 883. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. J. Barreiro, T. A. Ellison, J. A. Williams, M. L. Durr, D. E. Cameron, and L. A. Vricella Subclavian flap aortoplasty: still a safe, reproducible, and effective treatment for infant coarctation Eur. J. Cardiothorac. Surg., April 1, 2007; 31(4): 649 - 653. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Inglessis and M. J. Landzberg Interventional Catheterization in Adult Congenital Heart Disease Circulation, March 27, 2007; 115(12): 1622 - 1633. [Full Text] [PDF]
|
|
|
|
|
|
A. C. Marshall and J. E. Lock Leaving Neverland: A Randomized Trial for Coarctation Shows Pediatric Interventional Cardiology Is Growing Up Circulation, June 28, 2005; 111(25): 3347 - 3348. [Full Text] [PDF]
|
|
|
|
|
|
C. G. Cowley, G. S. Orsmond, P. Feola, L. McQuillan, and R. E. Shaddy Long-Term, Randomized Comparison of Balloon Angioplasty and Surgery for Native Coarctation of the Aorta in Childhood Circulation, June 28, 2005; 111(25): 3453 - 3456. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W.J. Vriend, A. H. Zwinderman, E. de Groot, J. J.P. Kastelein, B. J. Bouma, and B. J.M. Mulder Predictive value of mild, residual descending aortic narrowing for blood pressure and vascular damage in patients after repair of aortic coarctation Eur. Heart J., January 1, 2005; 26(1): 84 - 90. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Walhout, J. C. Lekkerkerker, G. H. Oron, G. B.W.E. Bennink, and E. J. Meijboom Comparison of surgical repair with balloon angioplasty for native coarctation in patients from 3 months to 16 years of age Eur. J. Cardiothorac. Surg., May 1, 2004; 25(5): 722 - 727. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. F. Corno, U. Botta, M. Hurni, M. Payot, N. Sekarski, P. Tozzi, and L. K. von Segesser Surgery for aortic coarctation: a 30 years experience Eur. J. Cardiothorac. Surg., December 1, 2001; 20(6): 1202 - 1206. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Hamdan, S. Maheshwari, J. T. Fahey, and W. E. Hellenbrand Endovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1518 - 1523. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Rosenthal Stent implantation for aortic coarctation: the treatment of choice in adults? J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1524 - 1527. [Full Text] [PDF]
|
|
|
|
 |
|
 J. L GIBBS Treatment options for coarctation of the aorta Heart, July 1, 2000; 84(1): 11 - 13. [Full Text]
|
|
|
|
|
|
J. Therrien, S. A. Thorne, A. Wright, P. J. Kilner, and J. Somerville Repaired coarctation: a "cost-effective" approach to identify complications in adults J. Am. Coll. Cardiol., March 15, 2000; 35(4): 997 - 1002. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E. Brickner, L. D. Hillis, and R. A. Lange Congenital Heart Disease in Adults- First of Two Parts N. Engl. J. Med., January 27, 2000; 342(4): 256 - 263. [Full Text] [PDF]
|
|
|
|
 |
|
 N.P. Jenkins and C. Ward Coarctation of the aorta: natural history and outcome after surgical treatment QJM, July 1, 1999; 92(7): 365 - 371. [Full Text] [PDF]
|
|
|
|
|
|
S. F. Kaine, E. O'Brian Smith, A. R. Mott, C. E. Mullins, and T. Geva Quantitative Echocardiographic Analysis of the Aortic Arch Predicts Outcome of Balloon Angioplasty of Native Coarctation of the Aorta Circulation, September 1, 1996; 94(5): 1056 - 1062. [Abstract] [Full Text]
|
|
|
|
 |
|
 ANGIOPLASTY VS. SURGERY FOR AORTIC COARCTATION Journal Watch (General), March 23, 1993; 1993(323): 5 - 5. [Full Text]
|
|