Long-term effects of balloon angioplasty on left ventricular hypertrophy in adolescent and adult patients with native coarctation of the aorta. Up to 18 years follow-up results.
BACKGROUND
Little is known regarding the long-term follow-up results of balloon angioplasty (BA) for patients with native aortic coarctation (AC) on left ventricular hypertrophy (LVH) regression.


OBJECTIVE
The purpose of this study was to define the long-term effect of BA of AC on LVH in adolescent and adult patients.


METHODS
Follow-up data of 53 patients (36 male) mean age 24 +/- 9 years undergoing BA for discrete AC at median interval of 11.8 years (range 4-18 years) including cardiac catheterization, magnetic resonance imaging, and Echocardiography form the basis of this study. Patients were divided into two groups at 1 year after BA based on absence (group A) or presence (group B) of persistent hypertension and need for medication.


RESULTS
Forty-nine patients had baseline LVH, BA produced an immediate reduction in peak AC gradient from 66 +/- 23 mm Hg (95% confidence interval [CI]: 59.5-72.7) to 10.8 +/- 7 mm Hg (95% CI: 8.8-12.5) (P < 0.0001). Follow-up catheterization 12 months later revealed a residual gradient of 6.2 +/- 6 mm Hg (95% CI: 4.4-7.9) (P < 0.001). The blood pressure had normalized without medication in 38 of the 49 patients (165 +/- 17 to 115 +/- 10 mm Hg). Left ventricular mass index (LVMI) decreased significantly (>20% decrease LVMI from baseline) in 48 patients (98%) at median interval 1.4 years (range 0.5-3 years) post BA, group A (38 patients) LVMI decreased from 132 +/- 30.7 g/m(2) (95% CI: 122-141.9) to 86 +/- 19.9 g/m(2) (95% CI: 79.5-92.5) (P < 0.0001). Similarly, in 10 patients (group B) the LVMI decreased from 157 +/- 38.7 g/m(2) (95% CI: 127-185) to 102 +/- 29 g/m(2) (95% CI: 105-151) (P < 0.0001) at follow-up. Mild (<20% decrease in LVMI) regressions were noted in one patient from group B. There was no progression to LVH in the four patients who had normal baseline LVMI.


CONCLUSIONS
(1) Long-term results of BA for discrete AC are excellent and should be considered as first option for treatment of this disease; (2) Regression of LVH (> or =20% reduction in LVMI) occurred in 98% of patients after BA.
Hassan
Walid
W
King Faisal Heart Institute, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. hassanw@kfshrc.edu.sa
Awad
Mahmoud
M
Fawzy
Mohamed Eid
ME
Omrani
Ahmad Al
AA
Malik
Shahid
S
Akhras
Nathem
N
Shoukri
Mohamed
M
D000293:Adolescent; D000328:Adult; D000800:Angioplasty, Balloon / Q000379:methods*; D001017:Aortic Coarctation / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome