Causes of recoarctation after balloon angioplasty of unoperated aortic coarctation

https://doi.org/10.1016/0735-1097(89)90557-3Get rights and content
Under an Elsevier user license
open archive

Abstract

During the 35 month period ending December 1987, 30 children, aged 14 days to 13 years, underwent balloon angioplasty of unoperated aortic coarctation with resultant reduction in coarctation gradient from 43.6 ± 20.4 to 9.5 ± 7.6 mm Hg (p < 0.001). None of the patients required immediate surgical intervention. On the basis of results of 6 to 30 month follow-up catheterization data in 20 children, the patients were classified as follows: Group A, 13 patients with good results (gradient ≤20 mm Hg and no recoarctation on angiograms) and Group B, 7 patients with fair or poor results (gradient >21 mm Hg with or without recoarctation on angiography). No patient developed aortic aneurysm at the site of angioplasty.

Thirty variables were examined by multivariate logistic regression analysis and four factors were identified as risk factors for development of recoarctation: 1) age <12 months, 2) aortic isthmus < 2/3 the size of the ascending aorta immediately proximal to the right innominate artery, 3) coarcted aortic segment <3.5 mm before dilation, and 4) coarcted aortic segment <6 mm after angioplasty. The identification of risk factors may help in selection of patients for balloon angioplasty. Avoiding or minimizing the number of risk factors may help reduce the chance of recoarctation after angioplasty.

The intermediate-term follow-up results with regard to recoarctation are comparable with those after surgical repair of coarctation. Recoarctation after angioplasty was dealt with by repeat balloon angioplasty or surgical resection for those requiring treatment and clinical follow-up for the remaining children. These results suggest that balloon angioplasty for native coarctation is an effective alternative to a surgical approach.

Cited by (0)

This study was supported in part by a grant from the Oscar Rennebohm Foundation. Inc., Madison.