Late follow-up of balloon angioplasty in children with a native coarctation of the aorta.
Between May 1984 and April 1993, 59 children underwent balloon angioplasty of a native coarctation at our institution. The follow-up protocol included a cardiac catheterization 1 to 2 years after angioplasty, which was performed in 90% of patients with > or = 2 years follow-up. Angioplasty caused an acute decrease in peak systolic gradient from 46 +/- 2 to 15 +/- 2 mm Hg, without early aneurysm or emergent surgical intervention in any patient. Based on follow-up data, a satisfactory result was obtained in 38 patients (64%; 70% confidence limit: 58% to 71%), defined as a residual systolic gradient < 20 mm Hg and no aneurysm. In these patients the gradient decreased acutely from 43 +/- 2 to 9 +/- 1 mm Hg, was 6 +/- 1 mm Hg at follow-up catheterization, and 9 +/- 2 mm Hg by clinical evaluation 4.4 +/- 0.3 years after angioplasty. Twenty-one patients (36%; 70% confidence limit: 29% to 42%) had an unsatisfactory result due to a residual gradient > or = 20 mm Hg (n = 19) or aneurysm formation (n = 3), or both. Restenosis occurred in 6 patients, and occurred more in infants than in children > or = 12 months of age (3 of 5 infants vs 3 of 41 children, p = 0.01). Thus, balloon angioplasty provides an effective initial treatment strategy for native coarctation in most children aged > 12 months.
Mendelsohn
A M
AM
Department of Pediatrics, C. S. Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor 48109-0204.
Lloyd
T R
TR
Crowley
D C
DC
Sandhu
S K
SK
Kocis
K C
KC
Beekman
R H
RH
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000800:Angioplasty, Balloon; D001014:Aortic Aneurysm / Q000209:etiology; D001017:Aortic Coarctation / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D001794:Blood Pressure; D006328:Cardiac Catheterization; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D012008:Recurrence