title: Impact of re-coarctation following the Norwood operation on survival in the balloon angioplasty era.
abstract: OBJECTIVE
  The objective of this study was to determine the efficacy of balloon angioplasty (BA) by comparing the immediate and long-term outcomes of patients with and without re-coarctation after a Norwood procedure.
  
  
  BACKGROUND
  Although BA has become the standard means for treating recurrent coarctation following a Norwood operation, it has been suggested that re-coarctation remains a significant cause of morbidity and mortality.
  
  
  METHODS
  Patients who survived a Norwood operation from December 1986 through June 2001 were studied. Differences between groups were evaluated by t test and logistic regression. Survival differences were tested by log-rank tests using Kaplan-Meier survival curves.
  
  
  RESULTS
  Fifty-eight of 633 patients underwent treatment for re-coarctation (9.2%). Thirty-five patients underwent BA (before 1988, 23 had surgery). Median age at catheterization was 6.6 months (1.9 to 35.6 months). Balloon angioplasty was successful (gradient <10 mm Hg) in 32 of 35 patients (92%). There were no BA-related deaths or neurologic complications. Recurrent obstruction after BA occurred in seven patients (20%); five underwent re-dilation. Kaplan-Meier estimates of freedom from recurrent obstruction after initial BA were 97% at one month, 79% at one year, and 79% at five years. There were no differences in survival between patients with re-coarctation treated by BA and patients who did not undergo treatment for re-coarctation.
  
  
  CONCLUSIONS
  We found that 9.2% of patients underwent treatment for re-coarctation following a Norwood operation. Balloon angioplasty is effective, with low morbidity, no early mortality, and no difference in long-term survival when compared with patients who did not have re-coarctation. Recurrent coarctation following BA occurred in 17% of patients, usually within the first year after BA.
authors.affiliation: Division of Cardiology, The Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Ilana
authors.initials: I
authors.lastname: Zeltser
authors.forename: Jondavid
authors.initials: J
authors.lastname: Menteer
authors.forename: J William
authors.initials: JW
authors.lastname: Gaynor
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Spray
authors.forename: Bernard J
authors.initials: BJ
authors.lastname: Clark
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Kreutzer
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rome
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D001017:Aortic Coarctation / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002675:Child, Preschool; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000601:surgery*; D007223:Infant; D012008:Recurrence; D016019:Survival Analysis