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Percutaneous Interventions on Severe Coarctation of the Aorta: A 21-Year Experience

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Abstract

Different percutaneous interventions can be used to treat coarctation of the aorta. However, a great amount of information is still needed regarding the long-term course. This article reviews our experience spanning 21 years in the percutaneous treatment of aortic coarctation. Four different conditions for treatment were considered. The first condition 1 (group 1) was balloon angioplasty in neonates and infants with untractable heart failure (n = 54; mean age, 1.2 ± 1.4 months). After balloon angioplasty, most infants sustained significant clinical improvement. However, 9 patients died in the hospital (17%). As a result, we monitored the course of the 45 survivors during a mean period of 10 ± 6 years (range, 1–19). During this follow-up period, 17 patients needed a single additional intervention on coarctation (8 underwent surgery and 9 were treated percutaneously). After this second treatment, 11 patients needed one or more further interventions. The actuarial survival probability was 83% at 19 years, with 43% of patients remaining surgery free and 23% re-intervention free. The second condition (group 2) was balloon angioplasty in children and adults with coarctation of the aorta before the stenting era (n = 28; mean age, 13 ± 8 years). After treatment, serial hemodynamic and angiographic studies were performed. The long-term relief was higher in patients with a discrete type of coarctation. The rate of late aneurysm formation was 6%. The third condition (group 3) was stent palliation in infants and children younger than the age of 6 years (n = 17; mean age, 2.1 ± 1.7 years). The stent was implanted for nondilatable stenoses, as a nondefinitive procedure. Stent palliation provides complete initial relief in hypoplastic coarctations or life-threatening conditions. However, further stent expansion is required to ensure adequate stent diameter in the growing aortic wall. In addition, late intrastent proliferation may occur in small stent diameters (18%) and aneurysm formation in hypoplastic coarctations (18%). Both late complications can be managed percutaneously. The fourth condition (group 4) was stent repair of severe aortic coarctation in adults, adolescents, and children older than the age of 6 years (n = 73; mean age, 20 ± 12 years). Significant relief was observed after treatment, which persisted at follow-up. One patient died at treatment (1.3%). After a mean follow-up of 5 ± 3 years, all 72 patients remained symptom free and no restenosis or late aneurysm were detected.

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References

  1. J Alcibar N Pena A Onate et al. (2000) ArticleTitlePrimary stent implantation in aortic coarctation: mid-term follow-up Rev Esp Cardiol 53 797–804 Occurrence Handle10944972

    PubMed  Google Scholar 

  2. HD Allen GR Marx TW Ovitt SJ Goldberg (1986) ArticleTitleBalloon dilation angioplasty for coarctation of aorta Am J Cardiol 57 828–832 Occurrence Handle10.1016/0002-9149(86)90622-3 Occurrence Handle2938463

    Article  PubMed  Google Scholar 

  3. RH Beekman AP Roccini M Dick SuffixII et al. (1987) ArticleTitlePercutaneous balloon angioplasty for native coarctation of the aorta J Am Coll Cardiol 10 1078–1084 Occurrence Handle2959709

    PubMed  Google Scholar 

  4. M Bonvicini A Giardini FM Picchio (2000) ArticleTitleLong-term natural history and follow-up of children operated for congenital heart disease Ital Heart J 1 105–107

    Google Scholar 

  5. F Bouchart A Dubar A Tabley et al. (2000) ArticleTitleCoarctation of the aorta in adults: surgical results and long-term follow-up Ann Thorac Surg 70 1483–1488 Occurrence Handle10.1016/S0003-4975(00)01999-8 Occurrence Handle11093474

    Article  PubMed  Google Scholar 

  6. ZR Bulbul E Bruckheimer JC Love JT Fahey WE Hellenbrand (1996) ArticleTitleImplantation of balloon-expandable stents for coarctation of the aorta: implantation data and short term results Cath Cardiovasc Diag 39 36–42 Occurrence Handle10.1002/(SICI)1097-0304(199609)39:1<36::AID-CCD7>3.0.CO;2-3

    Article  Google Scholar 

  7. M Cohen V Fuster PM Steele D Driscoll DC McGoon (1989) ArticleTitleCoarctation of the aorta. Long-term follow-up and prediction of outcome after surgical correction Circulation 80 840–845 Occurrence Handle2791247

    PubMed  Google Scholar 

  8. RS Cooper SB Ritter WB Rothe et al. (1987) ArticleTitleAngioplasty for coarctation of the aorta: long term results Circulation 75 600–604 Occurrence Handle2949888

    PubMed  Google Scholar 

  9. JV Giovanni Particlede (2001) ArticleTitleCovered stents in the treatment of aortic coarctation J Interv Cardiol 14 187–190 Occurrence Handle12053302

    PubMed  Google Scholar 

  10. C Duke E Rosenthal SA Qureshi (2003) ArticleTitleThe efficacy and safety of stent redilatation in congenital heart disease Heart 89 905–912 Occurrence Handle10.1136/heart.89.8.905 Occurrence Handle12860870

    Article  PubMed  Google Scholar 

  11. MR Ebeid LR Prieto L Latson (1997) ArticleTitleUse of balloon-expandable stents for coarctation of the aorta: initial results and intermediate-term follow-up J Am Coll Cardiol 7 1847–1852 Occurrence Handle10.1016/S0735-1097(97)00408-7

    Article  Google Scholar 

  12. ME Fawzy M Awad W Hassan et al. (2004) ArticleTitleLong-term outcome (up to 15 years) of balloon angioplasty of discrete native coarctation of the aorta in adolescents and adults J Am Coll Cardiol 43 1062–1067 Occurrence Handle10.1016/j.jacc.2003.10.040 Occurrence Handle15028367

    Article  PubMed  Google Scholar 

  13. ME Fawzy V Sivanandam O Galal et al. (1997) ArticleTitleOne- to ten-year follow up results of balloon angioplasty of native coarctation of the aorta in adolescents and adults J Am Coll Cardiol 30 1542–1546 Occurrence Handle10.1016/S0735-1097(97)00350-1 Occurrence Handle9362414

    Article  PubMed  Google Scholar 

  14. JP Finley RG Beaulien MA Nanton DL Roy (1983) ArticleTitleBalloon catheter dilatation of coarctation of the aorta in young infants Br Heart J 50 411–415 Occurrence Handle6227327

    PubMed  Google Scholar 

  15. RG Grifka W Vick SuffixIII MP O’Laughlin (1993) ArticleTitleBalloon expandable intravascular stents: aortic implantation and late further dilation in growing minipigs Am Heart J 126 979–984 Occurrence Handle10.1016/0002-8703(93)90715-L Occurrence Handle8213458

    Article  PubMed  Google Scholar 

  16. MA Hamdan S Maheshwari JT Fahey WE Hellenbrand (2001) ArticleTitleEndovascular stents for coarctation of the aorta: initial results and intermediate-term follow-up J Am Coll Cardiol 38 1518–1523 Occurrence Handle10.1016/S0735-1097(01)01572-8 Occurrence Handle11691533

    Article  PubMed  Google Scholar 

  17. DA Harrison PR McLaughlin C Lazzam M Connelly LN Benson (2001) ArticleTitleEndovascular stents in the management of coarctation of the aorta in the adolescent and adult: one year follow up Heart 85 561–566 Occurrence Handle10.1136/heart.85.5.561 Occurrence Handle11303011

    Article  PubMed  Google Scholar 

  18. JM Isner RF Donaldson D Fulton et al. (1987) ArticleTitleCystic medial necrosis in coarctation of the aorta: a potential factor contributing to adverse consequences observed after percutaneous balloon angioplasty of coarctation sites Circulation 75 689–695 Occurrence Handle2951035

    PubMed  Google Scholar 

  19. M Koller M Rothlin A Senning (1987) ArticleTitleCoarctation of the aorta: review of 362 operated patients. Long-term follow-up and assessment of prognostic variables Eur Heart J 8 670–679 Occurrence Handle3653118

    PubMed  Google Scholar 

  20. SJ Korkola CI Tchervenkov D Shum-Tim N Roy (2002) ArticleTitleAortic rupture after stenting of a native coarctation in an adult Ann Thorac Surg 74 936 Occurrence Handle10.1016/S0003-4975(01)03160-5 Occurrence Handle12238877

    Article  PubMed  Google Scholar 

  21. Z Lababidi (1983) ArticleTitleNeonatal transluminal balloon coarctation angioplasty Am Heart J 106 752–753 Occurrence Handle10.1016/0002-8703(83)90098-4 Occurrence Handle6225324

    Article  PubMed  Google Scholar 

  22. Z Lababidi D Daskapoulos H Stoeckle (1984) ArticleTitleBalloon coarctation angioplasty: experience with 27 patients Am J Cardiol 54 1288–1291 Occurrence Handle6209977

    PubMed  Google Scholar 

  23. M Ledesma C Alva FD Gomez et al. (2001) ArticleTitleResults of stenting for aortic coarctation Am J. Cardiol 88 460–462 Occurrence Handle10.1016/S0002-9149(01)01705-2 Occurrence Handle11545780

    Article  PubMed  Google Scholar 

  24. JE Lock (1984) ArticleTitleNow that we can dilate, should we? Am J Cardiol 54 1360 Occurrence Handle6239537

    PubMed  Google Scholar 

  25. JE Lock JL Bass K Amplatz BP Fuhrman WR Castañeda-Zuñiga (1983) ArticleTitleBalloon dilatation angioplasty of coarctations in infants and children Circulation 68 689–691

    Google Scholar 

  26. JE Lock WR Castañeda-Zuñiga JL Bass et al. (1982) ArticleTitleBalloon dilatation of excised aortic coarctation Radiology 143 689–691 Occurrence Handle6210934

    PubMed  Google Scholar 

  27. AG Magee G Brzezinska-Rajszys SA Qureshi et al. (1999) ArticleTitleStent implantation for aortic coarctation and recoarctation Heart 82 600–606 Occurrence Handle10525517

    PubMed  Google Scholar 

  28. BW McCrindle TK Jones WR Morrow et al. (1996) ArticleTitleAcute results of balloon angioplasty of native coarctation versus recurrent aortic obstruction are equivalent. Valvuloplasty and Angioplasty of Congenital Anomalies (VACA) registry investigators J Am Coll Cardiol 28 1810–1817 Occurrence Handle10.1016/S0735-1097(96)00379-8 Occurrence Handle8962571

    Article  PubMed  Google Scholar 

  29. WR Morrow J Palmaz FO Tio et al. (1993) ArticleTitleReexpansion of balloon-expandable stents after growth J Am Coll Cardiol 22 2007–20013 Occurrence Handle8245360

    PubMed  Google Scholar 

  30. WR Morrow VC Smith WJ Ehler AF VanDellen CE Mullins (1994) ArticleTitleBalloon angioplasty with stent implantation in experimental coarctation of the aorta Circulation 89 2677–2683 Occurrence Handle8205681

    PubMed  Google Scholar 

  31. VM Perez Martinez A Garcia Aguado F Moreno Granados MC Castro Gussoni M Burgueros (1983) ArticleTitleAngioplastia transluminal con cateter de Gruntzig en la coartación de aorta Rev Esp Cardiol 36 341–344 Occurrence Handle6227954

    PubMed  Google Scholar 

  32. JF Piechaud (2003) ArticleTitleStent implantation for coarctation in adults J Interv Cardiol 16 413–418 Occurrence Handle10.1046/j.1540-8183.2003.01004.x Occurrence Handle14603800

    Article  PubMed  Google Scholar 

  33. WA Radtke BR Waller A Hebra SM Bradley (2002) ArticleTitlePalliative stent implantation for aortic coarctation in premature infants weighing <1,500 g Am J Cardiol 90 1409–1412 Occurrence Handle10.1016/S0002-9149(02)02887-4 Occurrence Handle12480059

    Article  PubMed  Google Scholar 

  34. PS Rao (1993) Balloon angioplasty of native aortic coarctation PS Rao (Eds) Transcatheter Therapy in Pediatric Cardiology Wiley-Liss New York 153–196

    Google Scholar 

  35. PS Rao P Carey (1989) ArticleTitleRemodeling of the aorta following successful balloon coarctation angioplasty J Am Coll Cardiol 14 1312–1317 Occurrence Handle10.1016/0735-1097(89)90434-8 Occurrence Handle2530260

    Article  PubMed  Google Scholar 

  36. PS Rao O Galal PA Smith AD Wilson (1996) ArticleTitleFive- to nine-year follow up results of balloon angioplasty of native coarctation in infants and children J Am Coll Cardiol 27 462–470 Occurrence Handle10.1016/0735-1097(95)00479-3 Occurrence Handle8557921

    Article  PubMed  Google Scholar 

  37. PS Rao MK Thapar F Kutayli P Carey (1989) ArticleTitleCauses of recoarctation after balloon angioplasty of unoperated aortic aortic coarctation J Am Coll Cardiol 13 109–115 Occurrence Handle2521225

    PubMed  Google Scholar 

  38. AN Redington AM Hayes HS Yen (1993) ArticleTitleTranscatheter stent implantation to treat aortic coarctation in infancy Br Heart J 69 80–82 Occurrence Handle8457401

    PubMed  Google Scholar 

  39. E Rosenthal (2001) ArticleTitleStent implantation for aortic coarctation: the treatment of choice in adults? J Am Coll Cardiol 38 1524–1527 Occurrence Handle10.1016/S0735-1097(01)01573-X Occurrence Handle11691534

    Article  PubMed  Google Scholar 

  40. G Santoro M Carminati MC Bigazzi et al. (2001) ArticleTitlePrimary stenting of native aortic coarctation Tex Heart Inst J 28 226–227 Occurrence Handle11693122

    PubMed  Google Scholar 

  41. JP Saul JF Keane KE Fellows JE Lock (1987) ArticleTitleBalloon dilation angioplasty of postoperative aortic obstructions Am J Cardiol 59 943–948 Occurrence Handle10.1016/0002-9149(87)91130-1 Occurrence Handle2952000

    Article  PubMed  Google Scholar 

  42. MI Singer M Rowen TJ Dorsey (1982) ArticleTitleTransluminal aortic balloon angioplasty for coarctation of the aorta in the newborn Am Heart J 103 131–132 Occurrence Handle10.1016/0002-8703(82)90539-7 Occurrence Handle6459728

    Article  PubMed  Google Scholar 

  43. T Sos KW Sniderman B Rettek-Sos A Strupp DR Alonso (1979) ArticleTitlePercutaneous transluminal dilatation of coarctation of thoracic aorta postmortem Lancet 2 970–971 Occurrence Handle10.1016/S0140-6736(79)92675-8

    Article  Google Scholar 

  44. DR Sperling TJ Dorsey M Rowen A Gazzaniga (1983) ArticleTitlePercutaneous transluminal angioplasty of congenital coarctation of the aorta Am J Cardiol 51 562–564 Occurrence Handle6218748

    PubMed  Google Scholar 

  45. J Suárez de Lezo Particlede R Fernández M Sancho et al. (1984) ArticleTitlePercutaneous transluminal angioplasty for aortic isthmic coarctation in infancy Am J Cardiol 54 1147–1149

    Google Scholar 

  46. J Suárez de Lezo Particlede N Herrera M Sancho et al. (1984) ArticleTitleAngioplastia transluminal percutanea en la coartacián aórtica del adulto Rev Esp Cardiol 37 445–447 Occurrence Handle6240740

    PubMed  Google Scholar 

  47. J Suárez de Lezo Particlede A Medina M Pan et al. (2003) ArticleTitleFate of infants with severe coarctation of aorta treated early with balloon angioplasty. A 19-year study [abstract] J Am Coll Cardiol 41 488A

    Google Scholar 

  48. J Suárez de Lezo Particlede M Medina M Pan et al. (1996) ArticleTitleAortic arch reconstruction with balloon expandable stents [abstract] Eur Heart J 17 427

    Google Scholar 

  49. J Suárez de Lezo Particlede M Pan M Romero et al. (1999) ArticleTitleImmediate and follow-up findings after stent treatment for severe coarctation of aorta Am J Cardiol 83 400–406 Occurrence Handle10.1016/S0002-9149(98)00877-7 Occurrence Handle10072232

    Article  PubMed  Google Scholar 

  50. J Suárez de Lezo Particlede M Pan M Romero et al. (1995) ArticleTitleBalloon-expandable stent repair of severe coarctation of aorta Am Heart J 129 1002–1008 Occurrence Handle10.1016/0002-8703(95)90123-X Occurrence Handle7732957

    Article  PubMed  Google Scholar 

  51. J Suárez de Lezo Particlede M Sancho M Pan et al. (1989) ArticleTitleAngiographic follow up after balloon angioplasty for coactation of the aorta J Am Coll Cardiol 13 689–695 Occurrence Handle2521873

    PubMed  Google Scholar 

  52. BD Thanopoulos L Hadjinikolaou GN Konstadopoulou et al. (2000) ArticleTitleStent treatment for coarctation of the aorta: intermediate term follow up and technical considerations Heart 84 65–70 Occurrence Handle10.1136/heart.84.1.65 Occurrence Handle10862593

    Article  PubMed  Google Scholar 

  53. S Tyagi S Singh S Mukhopadhyay UA Kaul (2003) ArticleTitleSelf and balloon expandable stent implantation for severe native coarctation of aorta in adults Am Heart J 146 920–928 Occurrence Handle10.1016/S0002-8703(03)00434-4 Occurrence Handle14597945

    Article  PubMed  Google Scholar 

  54. B Uchytil J Cerny J Nicovsky et al. (2003) ArticleTitleSurgery for the coarctation of the aorta: long-term post-operative results Scripta Medica 76 347–356

    Google Scholar 

  55. C Wren I Peart H Bain S Hunter (1987) ArticleTitleBalloon dilation of unoperated aortic coarctation: immediate results and one year follow-up Br Heart J 58 369–373 Occurrence Handle3676023

    PubMed  Google Scholar 

  56. AT Yetman D Nykanen BW McCrindle et al. (1997) ArticleTitleBalloon angioplasty of recurrent coarctation: a 12 year review J Am Coll Cardiol 30 811–816 Occurrence Handle10.1016/S0735-1097(97)00228-3 Occurrence Handle9283545

    Article  PubMed  Google Scholar 

  57. C Zabal F Attie M Rosas A Buendia-Hernandez JA Garcia-Montes (2003) ArticleTitleThe adult patient with native coarctation of the aorta: balloon angioplasty or primary stenting? Heart 89 77–83 Occurrence Handle10.1136/heart.89.1.77 Occurrence Handle12482798

    Article  PubMed  Google Scholar 

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  1. Department of Cardiology, University Hospital, “Reina Sofía,” Avda. Menéndez Pidal 1, 14004 , Córdoba, Spain

    J. Suárez de Lezo, M. Pan, M. Romero, J. Segura, D. Pavlovic, S. Ojeda, J. Algar, R. Ribes, M. Lafuente & J. Lopez-Pujol

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  1. J. Suárez de Lezo
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  2. M. Pan
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  3. M. Romero
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  4. J. Segura
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  5. D. Pavlovic
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  7. J. Algar
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  9. M. Lafuente
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  10. J. Lopez-Pujol
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Correspondence to J. Suárez de Lezo.

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de Lezo, J.S., Pan, M., Romero, M. et al. Percutaneous Interventions on Severe Coarctation of the Aorta: A 21-Year Experience. Pediatr Cardiol 26, 176–189 (2005). https://doi.org/10.1007/s00246-004-0961-5

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