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Stenting the mildly obstructive aortic arch: useful treatment or oculo-inflatory reflex?
  1. K M English
  1. Correspondence to:
    Dr Kate English
    Adult Congenital Heart Disease Unit, Leeds General Infirmary, Great George Street, Leeds, LS1 3EX, UK; kate.english{at}leedsth.nhs.uk

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The relative risks and benefits of the physical relief of mild aortic arch obstruction by angioplasty and stenting remain unclear

Despite many years of surgical and more recently percutaneous therapy for coarctation of the aorta, patients continue to suffer from hypertension and its complications in the long term. Because of a paucity of robust data, the optimum mode of treatment for patients with mild aortic obstruction and arterial hypertension remains unclear.

In this issue of Heart, Boshoff et al describe their experience of stenting hypoplastic aortic arch segments in patients with mild pressure gradients and arterial hypertension. The intervention was technically successful in all patients with the only reported complications being two moderate groin haematomas. There was an immediate reduction in invasively measured peak pressure gradient across the stented hypoplastic area, but many of the treated patients remain hypertensive at short term follow-up.1

BALLOON ANGIOPLASTY AND STENTING

As equipment used for stenting aortic arch obstruction has become more refined and operators more experienced, balloon angioplasty and stenting for aortic coarctation has become commonplace, and has overtaken surgical intervention as the treatment of choice for aortic coarctation or re-coarctation, particularly in adolescents and adults in many centres. This change in practice is reflected by the profusion of case reports and relatively small series reports in the last 10 years.2–4 Employment of the technique is also supported by current National Institute for Health and Clinical Excellence (NICE) guidelines published in 2004.

Patients born with coarctation of the aorta die, and suffer more cardiovascular morbidity, at a younger age than their contemporaries, mostly due to the complications of hypertension. Disappointingly, even following apparently successful coarctation repair, arterial hypertension occurs in 20% of children and at least 25% of adults.5,6 Although young patients with hypertension have a low absolute risk of developing cardiovascular …

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