What are the intermediate-term results of balloon angioplasty in the repair of coarctation of the aorta (CoA)?

Updated: Nov 20, 2018
  • Author: Syamasundar Rao Patnana, MD; Chief Editor: Stuart Berger, MD  more...
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Answer

Several investigators have reported 1-year to 2-year follow-up results, and these studies suggest continued improvement. From the authors' study, 60 patients (58 catheterization, 2 clinical) were observed; the residual gradients 14 ± 11 (mean ± standard deviation [SD]) months following angioplasty remained low at 16 ± 15 mm Hg. [67] These gradients continue to be lower (P< .001) than those prior to angioplasty (46 ± 17 mm Hg) and are slightly higher (P< .05) than the gradients (11 ± 9 mm Hg) immediately following angioplasty. The angiographically measured coarctation segment remained wide. Only a modest increase is found (11 ± 9 vs 16 ± 15 mm Hg; P< .05) in peak gradients for the group as a whole, but, when individual patient values are examined, 15 (25%) of the 60 patients had evidence of recoarctation, defined as a peak-to-peak systolic pressure gradient in excess of 20 mm Hg.

The incidence of recoarctation is higher in neonates (5 [83%] of 6; P< .01) and infants (7 [39%] of 18; P =.011) than in children (3 [8%] of 36). Ten of these children underwent repeat balloon angioplasty, and their gradients were reduced (P< .001) from 39 ± 11 mm Hg to 10 ± 6 mm Hg. [67] Early in the authors' experience, 2 patients underwent surgical resection with good results. The final 3 children had no discrete narrowing and had no hypertension; therefore, no intervention was recommended. Aneurysms developed in 3 (5%) of 58 patients who underwent follow-up angiography; one of these patients required surgical excision of the aneurysm and the other 2 are observed clinically.

Similar high recoarctation rates were documented by our group [68, 69] in neonates and infants less than three months of age, but balloon angioplasty provided successful and effective palliation in 92% infants.


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