Is balloon angioplasty used in the repair coarctation of the aorta (CoA) in adults?

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

Although balloon angioplasty of aortic coarctation has most frequently been used in neonates, infants, and children, it can also be used in adult patients.

Lababidi et al (1984) were the first to apply this technique in a 27-year-old man, resulting in reduction of peak systolic pressure gradient across the coarctation (from 70 to 15 mm Hg), angiographic improvement, and reduced hypertension (190/124 mm Hg vs 130/80 mm Hg). They subsequently reported their experience with balloon dilatation of native coarctation in 8 consecutive adults, aged 19-30 years (25 ± 5 y). [72] The systolic pressure gradient across the coarctation was reduced from 48 ± 19 mm Hg to 7 ± 5 mm Hg. The size of the coarcted segment increased from 6.8 ± 2.2 mm to 15.2 ± 5 mm. No complications were encountered. Clinical and echo-Doppler follow-up one year after the procedure revealed good results, with no more than 15 mm Hg peak systolic blood pressure difference between the arms and the legs (measured by cuff). They concluded that results in young adults are similar to those observed inchildren,balloonangioplastyshouldbeconsideredasanoptiontosurgicalintervention, and follow-up studies (>1 y) are required.

Other reports followed, which revealed equally good results. [73] Based on a review of these studies, aortic perforation during the procedure and aneurysmal formation at follow-up are also apparent in adults. In addition, intimal dissection that persisted at 6-month follow-up was seen in one patient. Therefore, (1) avoiding manipulation to the tips of the catheters and guide wires in the region of freshly dilated coarctation, (2) choosing an appropriate-sized balloon (no larger that the diameter of the descending aorta at the level of the diaphragm), and (3) monitoring for the development of aneurysms and, if found, closely following the progression of aneurysms with repeated angiography or MRI are prudent guidelines. Twenty-year follow-up for discrete coarctations appear encouraging. [74]


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