Balloon angioplasty for native coarctation of the aorta in children and adults: factors determining the outcome.
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 less than 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 less than 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 re-coarctation after initial fall in the trans-coarctation 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 less than 3.0; (2) size of post-coarctation descending aorta/size of isthmus ratio greater than 1.75; (3) size of coarcted segment after angioplasty/size of coarcted segment before angioplasty ratio less than 2.0; and (4) size of balloon/size of coarcted segment ratio less than 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 less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
Ray
D G
DG
Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.
Subramanyan
R
R
Titus
T
T
Tharakan
J
J
Joy
J
J
Venkitachalam
C G
CG
Balakrishnan
K G
KG
D000293:Adolescent; D000328:Adult; D000792:Angiography; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D001017:Aortic Coarctation / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D001027:Aortography; D002648:Child; D002675:Child, Preschool; D003663:Decision Trees; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome