Transluminal balloon coarctation angioplasty: Experience with 27 patients

doi:10.1016/S0002-9149(84)80083-1

The American Journal of Cardiology

Volume 54, Issue 10, 1 December 1984, Pages 1288-1291

https://doi.org/10.1016/S0002-9149(84)80083-1 Get rights and content

Transluminal balloon angioplasty (BA) was performed in 27 consecutive patients with coarctation of the aorta (COA), including 7 infants with preductal COA, 7 patients with restenosed COA after surgical repair, and 13 older children and 1 adult with unoperated COA. The patients were 4 days to 27 years old. The balloon was positioned across the COA and inflated sequentially to pressures of 100 and 120 psi, each inflation lasting for 5 to 10 seconds. Peak systolic pressure gradient (PSG) across the COA was recorded and an aortogram was performed before and immediately after BA. PSG also was recorded during follow-up studies performed in 13 patients 3 to 24 months after BA. BA was performed without complications in each patient. Immediately after BA, the mean PSG was reduced from 49 ± 21 to 10 ± 7 mm Hg (p <0.01), and the mean COA diameter increased from 3.9 ± 1.4 to 9.6 ± 3.6 mm (p <0.01). After a follow-up period of 3 to 24 months, the mean PSG remained low (15 ± 11 mm Hg) and the mean COA diameter increased to 10.5 ± 4.6 mm. BA can be performed safely. It can be a useful palliative treatment in seriously ill infants with COA.

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Citation Excerpt :
Surgery had been the standard therapy for COA until Sos et al. (56) in 1979 showed that excised segments of coarcted aorta could be dilated. After that, the technique was used and modified, and the results were reported (57–59). Indications for balloon dilation of COA are basically the same as those for surgery, which include hypertension proximal to the coarctation with a resting systolic pressure gradient across the narrowed segment >20 mm Hg or angiographically severe coarctation with extensive collaterals (53).
The field of pediatric cardiac interventions has witnessed a dramatic increase in the number and type of procedures performed. We review the most common procedures performed in the catheter laboratory. Lesions are divided according to their physiological characteristics into left-to-right shunting lesions (atrial septal defect, patent ductus arteriosus, ventricular septal defect), right-to-left shunting lesions (pulmonary stenosis, pulmonary atresia/intact ventricular septum), right heart obstructive lesions (peripheral arterial pulmonic stenosis, right ventricular outflow tract obstruction), and left heart obstructive lesions (aortic valve stenosis, coarctation of the aorta). In addition, a miscellaneous group of lesions is discussed.
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La angioplastia percutánea de la coartación nativa en la edad pediátrica es una técnica controvertida. El objetivo de este estudio es aportar nuestra experiencia con esta técnica, y comparar retrospectivamente los resultados obtenidos en 2 períodos distintos.
Los 53 pacientes tratados con angioplastia se dividieron en 2 grupos: a) tratados entre 1985 y 1988 (n = 26), y b) tratados entre 1993 y 2003 (n = 27). Se realizó seguimiento en todos.
La angioplastia fue inicialmente efectiva (gradiente < 20 mmHg) en 18/26 pacientes del grupo A (69,2%), y en 22/27 (81,5%) en el grupo B. Presentaron recoartación el 33% del grupo A y el 25,6% del grupo B. Los pacientes recoartados del grupo A fueron derivados a cirugía, mientras que en 5 pacientes del grupo B se realizó una segunda angioplastia. Al final del seguimiento, se había conseguido una angioplastia efectiva en el 62% (16/26) en el grupo A frente al 85% (23/27) en el grupo B. La incidencia de complicaciones graves fue menor en el grupo B (4%) que en el A (19,2%), así como la de aneurismas (grupo B: 4%; grupo A: 15%).
La angioplastia percutánea es una alternativa eficaz en el tratamiento de la coartación nativa, circunscrita. La mejor selección de los casos, la utilización de balones de menor perfil y la optimización de los cuidados generales puede disminuir la incidencia de complicaciones. La aplicación de una segunda angioplastia (simple o con stent) en los casos de recoartación ha mejorado los resultados de esta técnica.
The use of balloon angioplasty to treat native aortic coarctation in pediatric patients is controversial. Our aims were to report our experience with this technique and to compare retrospectively the immediate and medium-term results obtained during 2 distinct time periods.
53 patients who underwent balloon angioplasty for native coarctation were divided into 2 groups: (A) those treated between 1985-1988 (n=26); and (B) those treated between 1993-2003 (n=27). Follow-up data were available for all patients.
The immediate result was good (i.e., pressure gradient, <20 mmHg) in 18/26 patients in group A (69.2%) and 22/27 (81.5%) in group B. On follow-up, the recoarctation rate was similar in both groups: 33% in group A and 25.6% in group B. Group A patients with recoarctation were referred for surgery, whereas group B patients underwent a second angioplasty (either balloon or stent). At the end of follow-up, angioplasty had been successful in 62% (16/26) of patients in group A vs 85% (23/27) in group B. The incidence of serious complications was lower in group B (4%) than group A (19.2%), as was the incidence of aneurysm: 4% in group B vs 15% in group A.
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Transluminal balloon coarctation angioplasty: Experience with 27 patients

Am Heart J

Am J Cardiol

Am Heart J

Am J Cardiol

Coarctation of the aorta