721-3 Five-to-Nine Year Follow-up Results of Balloon Angioplasty of Native Aortic Coarctation

Controversy exists with regard to the role of balloon angioplasty in the treatment of native aortic coarctation. In an attempt to evaluate the usefulness of this procedure we reviewed our experience with this procedure with a special emphasis on follow-up results.During an 8.7-year-period ending September 1993, 67 neonates, infants and children underwent balloon angioplasty with resultant reduction in peakto- peak coarctation gradient from 48±19 (mean ±SD)to 11±9mmHg (P<0.001). None required immediate surgical intervention. At intermediate-term follow-up, catheterization (58 patients) and blood pressure (2 patients) data revealed a residual gradient of 16±15mmHg. When individual results were scrutinized 15 of 60 (25%) had recoarctation, defined as peak gradient>20mmHg. Recoarctation was higher (P<0.01) in neonates [5 of 6 (83%)] and infants [7 of 18 (39%)] than in children [3 of 36 (8%)], respectively. Two infants in our early experience had surgical resection with excellent results. Three patients had no discrete narrowing but had normal arm blood pressure and had no intervention. The remaining 10 patients had repeat balloon angioplasty with reduction of peak gradients from 52±13 to 9±8 mmHg (P<0.001). Reexamination 31±18 months after repeat angioplasty revealed a residual gradient of 3 to 19 (11±6) mmHg. Three (5%) of 58 patients who underwent follow-up angiography developed aneurysms. One child had a moderate aneurysm and surgical resection was performed without difficulty. During 1 and 4 year follow-up, no further increase in the size of the aneurysm occurred in the remaining two children.Blood pressure, echo-Doppler and repeat angiographic or magnetic resonance imaging data 5 to 9 years after angioplasty revealed no new aneurysms, normal blood pressures in 77% patients, and minimal (2%) late recoarctation.Based on these data it is concluded that balloon angioplasty is safe and effective in the treatment of native aortic coarctation; significant incidence of recoarctation is seen in neonates and infants; repeat balloon angioplasty for recoarctation is feasible and effective; 5 to 9 year follow-up is encouraging; and the time has come to consider balloon angioplasty as a therapeutic procedure of choice for the treatment of native aortic coarctation