BALLOON ANGIOPLASTY FOR NATIVE COARCTATION OF THE AORTA IN CHILDREN AND ADULTS - FACTORS DETERMINING THE OUTCOME
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Date
1992
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INTERNATIONAL JOURNAL OF CARDIOLOGY
Abstract
Balloon angioplasty was performed in 46 patients (age 2-40 yr) with discrete native coarctation of aorta. Patients with associated patent ductus arteriosus, aberrant subclavian artery and aneurysms were excluded. The peak systolic gradient across the coarcted segment decreased from 52.1 +/- 18.5 mmHg to 18.6 +/- 14.8 mmHg (p < 0.001), and the diameter of the coarcted segment increased from 3.6 +/- 1.7 mm/m2 to 9.1 +/- 3.2 mm/m2 (p < 0.001). Follow-up haemodynamic and angiographic studies performed in 21 patients at 13.1 +/- 6.9 months after angioplasty, showed good results in 15 patients. Four patients undergoing haemodynamic study and 4 other patients undergoing noninvasive evaluation were graded as having bad results at follow-up. In 5 of these patients the poor results were due to primary failure of angioplasty in relieving the gradient, and three developed recoarctation after initial fall in the transcoarctation gradient. Four risk factors were identified on univariate analysis, which were associated with significantly larger residual gradients at follow-up: (1) size of isthmus/size of coarcted segment ratio < 3.0; (2) size of post-coarctation descending aorta/size of isthmus ratio > 1.75; (3) size of coarcted segment after angioplasty/size of coarcted segment before angioplasty ratio < 2.0; and (4) size of balloon/size of coarcted segment ratio < 3.0. The presence of one or more risk factors was associated with bad late results. On multivariate analysis the ratio of balloon size/coarcted segment size was found to be the sole independent predictor of the late outcome (p < 0.02). One patient needed early surgery for false aneurysm, and 2 other patients were noted to have small and non-progressive aneurysms on follow-up. Patients with aneurysm formation were found to have relatively smaller isthmic diameters, and the balloon diameter exceeded the isthmus size in all 3 patients. We conclude that balloon angioplasty can be safely performed in patients with discrete native coarctation with satisfactory early results in 70% of patients. Among patients with adequate follow-up data the late outcome is good in 60%. With the identification of risk factors it should be possible to further improve results and minimise the risk of aneurysm formation.
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Cardiology
Citation
INTERNATIONAL JOURNAL OF CARDIOLOGY. 36; 3; 273-281